What is a Tiered Health Plan? Navigating This New Insurance Plan

What’s the first thing that comes to mind when you hear the word network? Perhaps it’s network television. Maybe it’s networking with professional peers or a network of machines.

In health care, a network is a group of health care providers. Depending on your plan, getting care from providers in a particular network may be more affordable for you.

To help meet consumer demand for flexible health care options, some HAP plans offer what are called tiered plans. You may be wondering, what is a tiered health plan? A tiered insurance plan has divided the in-network providers into two levels or tiers. The benefits you get with your plan are the same, but your costs change depending upon the tier level of the provider. Members with tiered health insurance plans often get care from providers in different tiers, but in most cases, you have the opportunity to choose which Tier you get care in.

Let’s say you select a Tier 1 doctor as your primary care physician, or PCP. Then your Tier 1 PCP decides you should see a Tier 2 specialist. You are free to see the Tier 2 specialist if you wish, but it may cost you more out of pocket. This is where doing some homework on health care providers could save you some money. Why? Because your PCP may not know the specialist is in a higher-cost tier. It’s your responsibility to check, and you should feel comfortable talking to your PCP about your options. If you ultimately decide to see the Tier 2 specialist, you’ll be responsible for paying Tier 2 costs for the care.

How to find out which Tier your health care provider is part of

If you’re already a HAP member, log in at hap.org and click on the "Find a Doctor/Facility" tab. This will take you to our provider search tool. There are two ways you can use the search tool to find a provider:

• By provider name: If the provider is in one of your networks, the information about that provider will include their tier level.
• By provider type: Pick a provider type under the Providers label, like “Primary Care Physician.” Then, you can narrow your search to tier level.

Once you log in, you’ll also have access to information about your costs for care from providers in each tier of your plan.

It’s really important to log in for your search. There are hundreds of different HAP plans. Logging in takes the guesswork off of you and shows you the doctors in your particular plan.

If you’re not a HAP member, visit hap.org and click on “Doctors” at the top of the page. Then click on “Change plan” to help you customize your search. If you select a tiered health plan, you will see each doctor’s tier level in your search results.

Your plan may have separate deductibles (the amount you owe before your health plan begins to pay) for different tiers. Your coinsurance amounts (the percentage of charges you’ll pay, usually after deductibles have been met) may differ for each tier as well.

To make the best health care decisions for you, it's good to know:

• Health care providers’ tiers.
• Your cost responsibilities for each tier.
• That payments toward a deductible in one tier are not applied to your deductible in another tier.