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Understanding health plan networks

Key information about networks and their importance.

What is a network?

A network is a group of healthcare providers, including doctors, hospitals and other medical facilities that have agreed to provide services at discounted rates to members of a specific health plan. Networks are designed to manage costs and ensure quality care.

Knowing your network is smart and helps you get the most from your plan.

See how it maximizes your MyPriority® plan benefits.

Using your plan network

Types of networks

  • Health maintenance organization (HMO): MyPriority individual and family plans are HMO plans. HMO plans generally require members to use in-network providers to receive the highest level of coverage.
  • Preferred Provider Organization (PPO): PPO plans generally offer greater flexibility by allowing members to receive care from both in-network and out-of-network providers, though out-of-pocket costs are usually higher when using out-of-network providers.
  • Narrow network: Narrow Network plans offer lower premiums and provide access to quality care within a specific network of doctors and affiliated providers.

What is a provider?

A provider is an individual doctor, clinic, hospital or other health care entity that offers medical services. Providers can be either in-network or out-of-network.

  • In-network providers have contracts with your insurance plan to offer services at reduced rates. Using in-network providers usually means lower out-of-pocket costs for you.
  • Out-of-network providers do not have contracts with your insurance plan. Using out-of-network providers typically results in higher costs, and some services may not be covered at all.

How do I check if my current provider is in-network?

It's important to check if your preferred doctors and hospitals are in-network to avoid higher out-of-pocket costs. If you have a MyPriority plan, there are a few ways to check if your doctor is in-network:

  1. Call your provider directly
  2. Speak with a Priority Health enrollment specialist
  3. Use Priority Health's Find a Doctor tool to check a specific network

What happens if I see an out-of-network provider?

Depending on your plan, seeing an out-of-network provider can result in higher costs or no coverage at all. Understanding your plan's out-of-network coverage can help you avoid unexpected costs.

Are there any restrictions on accessing specialists?

Requirements for seeing a specialist vary by health plan. While some plans require a referral from a primary care provider (PCP), MyPriority plans allow members to see in-network specialists without a referral.

Frequently asked questions

Emergency care is typically covered regardless of whether the provider is in-network or out-of-network, but it's important to check your plan's specific rules. It's a good idea to know this information before you need emergency care.

You can switch plans during the Open Enrollment Period (OEP) or if you qualify for a Special Enrollment Period (SEP) due to a qualifying life event (QLE).

Having a large network, like Priority Health, has many benefits, including:

  • Access to care: more options for doctors, specialists and hospitals
  • Convenience: easier to find nearby in-network providers
  • Continuity: likely includes your current healthcare providers
  • Cost savings: lower costs with in-network providers
  • Comprehensive coverage: access to a wide range of services
  • Emergencies: higher chance of nearby in-network emergency care
  • Flexibility: more choices for switching doctors or seeking second opinions

MyPriority members have access to a large network of high-quality primary care providers across Michigan. That – combined with our $0 virtual urgent care options – means members can get care when and where they need it. Plus, you'll get high-quality care with award-winning customer service.1

What is a Narrow Network plan?

Discover how a narrow network could help lower your costs – and decide if it’s the right choice for you.

Narrow Network plans

1 Priority Health was named to the America’s Best Customer Service in Financial Services list by USA TODAY for 2026, and to Newsweek’s America’s Best Customer Service list for 2025 and 2024.