We teach our kids about balance – eating ice cream and vegetables, having fun and playing safely, spending and saving their allowance. When it comes to health coverage, a network is one way quality care and cost savings are balanced. 

What is a network?

A network is the list of doctors, hospitals and other health care providers (pharmacies, mental health providers, urgent care clinics, etc.) a health plan contracts with to provide care to its members. Those on the list are considered “in-network providers” and those not on the list are considered “out-of-network providers.”

Keep in mind, different plans may have different networks even if they are from the same coverage provider. 

How are my health care costs impacted by my network? 

It’s important to know what type of network comes with your plan because the amount you pay for care is often tied to your network. For instance, your care may only be covered if you see an in-network provider, or you may have to pay more if you see an out-of-network provider or you may need to get a referral before seeing an out-of-network provider. 

Here are some of the different types of networks:

  • Health Maintenance Organization (HMO): With an HMO, you’re usually limited to care from in-network providers and aren’t covered for out-of-network care (except in an emergency). You may also be required to live or work in the HMO’s service area to qualify for coverage.
  • Preferred Provider Organization (PPO): With a PPO, you will pay less if you use in-network providers but, for an additional cost, you can use providers outside your network without a referral.
  • Narrow network: With a narrow network plan, you will typically have a lower monthly premium but are limited to care from in-network providers. If you receive care from an out-of-network provider, you’ll be responsible for the full cost of care (except in an emergency). Narrow networks are typically based on geographical areas, and you are required to live or work within that area. 

Your member ID or plan documents should tell you which type of plan you currently have.

How do I know if my child’s doctor is in a specific network?

Before you enroll in a new plan, there are a few ways to check if your preferred provider is in that plan’s network:

  • Call your provider.
  • Call an enrollment specialist or customer service representative at the health coverage company. You can reach a MyPriority enrollment specialist at 833.437.0360.
  • If you’re considering a plan from Priority Health, our free online Find a Doctor tool shows you which plans are accepted at providers, hospitals or other medical facilities near you. 

How do I choose the right network for my family?

There’s no one-size-fits-all health plan, so it’s important to choose the plan that works best for your family. You’ll want to consider your family’s current and potential health needs before choosing a plan. This can include:

  • Provider availability: Do you have a primary care physician you love, or would you be willing to switch?
  • Future needs: Do you currently have children? Are you planning to have more children? 
  • Specialist care: Do you or your children have any conditions that may require you to see a specialist on a routine basis? 
  • Travel: Does any of your family travel frequently or spend a long portion of time away from home?

All Priority Health plans come with a large network of high-quality providers. That, combined with our virtual urgent care and virtual primary care options, means you can get care when and where you need it, no matter which of our plans you choose. 

Can I switch plans if my network needs to change?

You can only switch plans during Open Enrollment or if you qualify for a Special Enrollment Period (SEP) due to a Qualifying Life Event (QLE). That’s why it’s so important to understand the different plan networks and what network will work best for your family.  

Priority Health is a nationally recognized nonprofit health benefits company focused on improving the health and lives of members across Michigan. Priority Health, part of the Corewell Health nonprofit health system is recognized as a leader for quality, customer service, transparency and product innovation.