What is a network of providers for which costs are covered inside, but not outside the network?

A network of providers for which costs are covered inside, but not outside the network, is best described by an HMO, or Health Maintenance Organization. HMOs emphasize preventive care and require members to choose a primary care physician (PCP) who oversees their health care services. When individuals seek medical services within the network, they benefit from lower costs because the services are negotiated and coordinated among providers. However, this structure typically does not cover any costs for out-of-network care unless there are exceptional situations, such as an emergency.

In contrast, other types of plans, such as PPOs (Preferred Provider Organizations) and POS (Point of Service) plans, offer more flexibility in choosing providers, allowing members to seek care outside their network, albeit at a higher cost. EPOs (Exclusive Provider Organizations) share similarities with HMOs but often have slightly more flexibility, usually covering limited out-of-network care in certain circumstances. Each of these options has different characteristics regarding provider networks and cost-sharing, but the definitive feature of an HMO is its strict adherence to in-network services for cost coverage.