MCDOWELLS PHARMACY INC
Accepted Insurance for NPI 1417618604
Pharmacy - Long Term Care Pharmacy in Scotland Neck, NC
Accepted Insurance & Health Plans Health Insurance Marketplace
Marketplace plan participation on file for this provider · 2026 plan year
MCDOWELLS PHARMACY INC, a pharmacy provider in Scotland Neck, NC, is listed as in-network for 1,004 health insurance plans from 17 insurance companies, led by Blue Cross and Blue Shield of Nebraska, Florida Blue (BlueCross BlueShield FL) and Dean Health Plan. This list is compiled from the CMS Health Insurance Marketplace public use files for the 2026 plan year.
Antidote Health Plan of Arizona, Inc.
Bronze Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Bronze Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Bronze Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Bronze Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Bronze Standard
Catastrophic Standard
Gold Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Gold Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Gold Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Gold Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Gold Standard
Silver Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Silver Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Silver Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Silver Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Silver Standard
Antidote Health Plan of Ohio, Inc.
Bronze Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Bronze Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Bronze Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Bronze Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Bronze Standard
Gold Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Gold Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Gold Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Gold Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Gold Standard
Silver Complete 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Silver Complete+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care, $0 Core Rx
Silver Elite 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Silver Elite+Dental 4 $0 Tier-1 PCP Visits, $0 Antidote 24/7 Virtual PCP/Urg/Chronic Care/Referred Labs, $0 Advanced Rx
Silver Standard
Avera Health Plans
ConnectPlus $0 Gold
ConnectPlus $0 Silver
ConnectPlus $10,600 HSA Eligible HDHP
ConnectPlus $1800
ConnectPlus $4500
ConnectPlus $6500 HSA Eligible HDHP
ConnectPlus $7500 HSA Eligible HDHP
ConnectPlus MyWeighForward $2000
ConnectPlus MyWeighForward $6000
ConnectPlus Standard $2000
ConnectPlus Standard $6000
ConnectPlus Standard $7500 HSA Eligible HDHP
DirectConnect $0 Gold
DirectConnect $0 Silver
DirectConnect $1800
DirectConnect $4500
DirectConnect $6500 HSA Eligible HDHP
DirectConnect $7500 HSA Eligible HDHP
DirectConnect MyWeighForward $2000
DirectConnect MyWeighForward $6000
DirectConnect Standard $2000
DirectConnect Standard $6000
DirectConnect Standard $7500 HSA Eligible HDHP
Baylor Scott and White Health Plan
BSW Diabetes Care Gold HMO 014
BSW Elite Gold HMO 001 (CMS Standardized Plan with $0 Pediatric PCP copay)
BSW Elite Gold HMO 004
BSW Elite Gold HMO 012
BSW Prime Silver HMO 003 (CMS Standardized Plan with $0 Pediatric PCP copay)
BSW Prime Silver HMO 008
BSW Prime Silver HMO 005
BSW Savers Bronze HMO H S A 006
BSW Savers Bronze HMO H S A 007 (CMS Standardized Plan with $0 Pediatric PCP copay)
BSW Savers Bronze HMO H S A 009
Blue Cross Blue Shield of North Dakota
BlueCare Bronze HSA Eligible $50 PCP Copay ($5 Value Based Drug List)
BlueCare Gold $10 PCP Copay ($5 Value Based Drug List)
BlueCare Silver $20 PCP Copay ($5 Value Based Drug List)
BlueDirect Bronze 100 HSA Eligible ($8000 Deductible / $5 Preventive Drug List)
BlueDirect Gold 90 HSA Eligible ($2600 Deductible / $5 Preventive Drug List)
BlueDirect Silver 80 HSA Eligible ($3500 Deductible / $5 Preventive Drug List)
BlueEssential Catastrophic 100 HSA Eligible $10600 Deductible
BlueValue Bronze HSA Eligible $50 PCP Copay (Standardized plan)
BlueValue Gold $30 PCP Copay (Standardized plan)
BlueValue Silver $40 PCP Copay (Standardized plan)
DakotaBlue Altru Gold ($5 Value Based Drug List)
DakotaBlue Altru Silver ($5 Value Based Drug List)
DakotaBlue Trinity Gold ($5 Value Based Drug List)
DakotaBlue Trinity Silver ($5 Value Based Drug List)
Blue Cross Blue Shield of Wyoming
BlueSelect Bronze Basic
BlueSelect Bronze Core
BlueSelect Expanded Bronze Standard without Kid's Dental
BlueSelect Gold Core
BlueSelect Gold HealthPlus
BlueSelect Gold Standard without Kid's Dental
BlueSelect Silver Classic without Kid's Dental
BlueSelect Silver Classic
BlueSelect Silver HealthPlus without Kid's Dental
BlueSelect Silver HealthPlus
BlueSelect Silver Standard without Kid's Dental
Blue Cross and Blue Shield of Alabama
Blue Access Gold for Business
Blue Choice Platinum for Business
Blue Cross Select Gold
Blue Cross Select Silver
Blue HSA Bronze
Blue HSA Silver for Business
Blue Protect
Blue Saver Bronze for Business
Blue Saver Bronze
Blue Saver Gold for Business
Blue Saver Silver EPO
Blue Secure Gold for Business
Blue Secure Silver for Business
Blue Standardized Bronze
Blue Standardized Gold
Blue Standardized Silver EPO
Blue Standardized Silver
Blue Standardized Statewide Silver EPO
Blue Statewide Silver EPO
Blue Value Gold
Blue Value Silver
Blue Cross and Blue Shield of Nebraska
HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue PPO
HeartlandBlue Bronze 0% Coinsurance after Deductible NEtwork Blue
HeartlandBlue Bronze 6000 Blueprint Health w/ Adult Vision
HeartlandBlue Bronze 6000 Premier Select BlueChoice w/ Adult Vision
HeartlandBlue Bronze HSA 6500 Blueprint Health
HeartlandBlue Bronze HSA 6500 NEtwork Blue PPO
HeartlandBlue Bronze HSA 6500 NEtwork Blue
HeartlandBlue Bronze HSA 6500 Premier Select BlueChoice
HeartlandBlue Bronze Standard 7500 Blueprint Health
HeartlandBlue Bronze Standard 7500 NEtwork Blue PPO
HeartlandBlue Bronze Standard 7500 NEtwork Blue
HeartlandBlue Bronze Standard 7500 Premier Select BlueChoice
HeartlandBlue Gold $0 PCP Visit 1500 Blueprint Health
HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue PPO
HeartlandBlue Gold $0 PCP Visit 1500 NEtwork Blue
HeartlandBlue Gold $0 PCP Visit 1500 Premier Select BlueChoice
HeartlandBlue Gold 1000 Blueprint Health w/ Adult Vision
HeartlandBlue Gold 1000 NEtwork Blue w/ Adult Vision PPO
HeartlandBlue Gold 1000 NEtwork Blue w/ Adult Vision
HeartlandBlue Gold 1000 Premier Select BlueChoice w/ Adult Vision
HeartlandBlue Gold Standard 2000 Blueprint Health
HeartlandBlue Gold Standard 2000 NEtwork Blue PPO
HeartlandBlue Gold Standard 2000 NEtwork Blue
HeartlandBlue Gold Standard 2000 Premier Select BlueChoice
HeartlandBlue Silver $0 PCP Visit 4500 Blueprint Health
HeartlandBlue Silver $0 PCP Visit 4500 NEtwork Blue PPO
HeartlandBlue Silver $0 PCP Visit 4500 NEtwork Blue
HeartlandBlue Silver $0 PCP Visit 4500 Premier Select BlueChoice
HeartlandBlue Silver 4000 Blueprint Health
HeartlandBlue Silver 4000 Premier Select BlueChoice
HeartlandBlue Silver HSA 5500 Blueprint Health w/ Adult Vision
HeartlandBlue Silver HSA 5500 NEtwork Blue w/ Adult Vision PPO
HeartlandBlue Silver HSA 5500 NEtwork Blue w/ Adult Vision
HeartlandBlue Silver HSA 5500 Premier Select BlueChoice w/ Adult Vision
HeartlandBlue Silver Standard 6000 Blueprint Health
HeartlandBlue Silver Standard 6000 NEtwork Blue PPO
HeartlandBlue Silver Standard 6000 NEtwork Blue
HeartlandBlue Silver Standard 6000 Premier Select BlueChoice
Blue Cross and Blue Shield of Oklahoma
Blue Advantage Bronze PPO℠ 202
Blue Advantage Bronze PPO℠ 203
Blue Advantage Bronze PPO℠ Standard
Blue Advantage Gold PPO℠ 309
Blue Advantage Gold PPO℠ 604
Blue Advantage Gold PPO℠ Standard
Blue Advantage Silver PPO℠ 204
Blue Advantage Silver PPO℠ 501
Blue Advantage Silver PPO℠ Standard
Blue Preferred Bronze PPO℠ Standard
Blue Preferred Gold PPO℠ Standard
Blue Preferred Security PPO℠ 200
Blue Preferred Silver PPO℠ Standard
MyBlue Bronze HMO℠ 902
MyBlue Bronze HMO℠ 904
MyBlue Bronze HMO℠ Standard
MyBlue Gold HMO℠ 704
MyBlue Gold HMO℠ 804
MyBlue Gold HMO℠ Standard
MyBlue Silver HMO℠ 705
MyBlue Silver HMO℠ 803
MyBlue Silver HMO℠ Standard
Blue Cross and Blue Shield of Texas
Blue Advantage Bronze HMO℠ 204
Blue Advantage Bronze HMO℠ 301
Blue Advantage Bronze HMO℠ Standard
Blue Advantage Gold HMO℠ 206
Blue Advantage Gold HMO℠ 603
Blue Advantage Gold HMO℠ Standard
Blue Advantage Plus Bronze℠ 303
Blue Advantage Plus Bronze℠ 305
Blue Advantage Plus Bronze℠ Standard
Blue Advantage Plus Gold℠ 203
Blue Advantage Plus Gold℠ 803
Blue Advantage Plus Gold℠ Standard
Blue Advantage Plus Silver℠ 202
Blue Advantage Plus Silver℠ 605
Blue Advantage Plus Silver℠ Standard
Blue Advantage Security HMO℠ 200
Blue Advantage Silver HMO℠ 205
Blue Advantage Silver HMO℠ 801
Blue Advantage Silver HMO℠ Standard
MyBlue Health Bronze℠ 402
MyBlue Health Bronze℠ Standard
MyBlue Health Gold℠ 403
MyBlue Health Gold℠ Standard
MyBlue Health Silver℠ 405
MyBlue Health Silver℠ Standard
Dean Health Plan
Dean Bronze $0 Copay PCP Visits
Dean Bronze Share
Dean Expanded Bronze Standard
Dean Focus Bronze $0 Copay PCP Visits
Dean Focus Bronze Share
Dean Focus Expanded Bronze Standard
Dean Focus Gold HSA
Dean Focus Gold Share
Dean Focus Gold Standard
Dean Focus Silver $0 Copay PCP Visits
Dean Focus Silver Share
Dean Focus Silver Standard
Dean Gold HSA
Dean Gold Share
Dean Gold Standard
Dean Silver $0 Copay PCP Visits
Dean Silver Share
Dean Silver Standard
Prevea360 Bronze HSA
Prevea360 Bronze Share
Prevea360 Expanded Bronze Standard
Prevea360 Gold HSA
Prevea360 Gold Share
Prevea360 Gold Standard
Prevea360 Silver $0 Copay PCP Visits
Prevea360 Silver Share
Prevea360 Silver Standard
Florida Blue (BlueCross BlueShield FL)
BlueOptions Bronze (HSA) 24J01-10 (Rewards / $4 Condition Care Rx)
BlueOptions Bronze 24J01-04 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards)
BlueOptions Bronze 24J01-06 (Rewards)
BlueOptions Bronze 24J01-17 ($50 PCP Visits / Rewards)
BlueOptions Bronze 24J01-18S ($50 PCP Visits / Rewards)
BlueOptions Gold 24J01-09 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards)
BlueOptions Gold 24J01-12 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards)
BlueOptions Gold 24J01-20S ($30 PCP Visits / $60 Specialist Visits / Rewards)
BlueOptions Platinum 24J01-05 ($0 Labs / $15 PCP Visits / $35 Specialist Visits / Rewards)
BlueOptions Platinum 24J01-08 ($0 Deductible / $0 Labs / $15 PCP Visits / $25 Specialist Visits / Rewards)
BlueOptions Platinum 24J01-21S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Rewards)
BlueOptions Silver 24J01-03 ($10 Labs / Rewards)
BlueOptions Silver 24J01-07 ($50 PCP Visits / Rewards)
BlueOptions Silver 24J01-19S ($40 PCP Visits / $80 Specialist Visits / Rewards)
BlueSelect Bronze (HSA) 1735 (Rewards / $4 Condition Care Rx)
BlueSelect Bronze 1449 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards)
BlueSelect Bronze 2139 ($50 PCP Visits / Rewards)
BlueSelect Bronze 2139E ($50 PCP Visits / Adult Dental & Vision / Rewards)
BlueSelect Bronze 2139V ($50 PCP Visits / Adult Vision / Rewards)
BlueSelect Bronze 2342S ($50 PCP Visits / Rewards)
BlueSelect Bronze 24L01-01 (Rewards)
BlueSelect Gold 1535 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards)
BlueSelect Gold 1535V ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Adult Vision / Rewards)
BlueSelect Gold 1835 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards)
BlueSelect Gold 2344S ($30 PCP Visits / $60 Specialist Visits / Rewards)
BlueSelect Platinum 1451 ($0 Labs / $15 PCP Visits / $35 Specialist Visits / Rewards)
BlueSelect Platinum 1457 ($0 Deductible / $0 Labs / $15 PCP Visits / $25 Specialist Visits / Rewards)
BlueSelect Platinum 2345S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Rewards)
BlueSelect Silver 1443 ($10 Labs / Rewards)
BlueSelect Silver 1443E ($10 Labs / Adult Dental & Vision / Rewards)
BlueSelect Silver 1443V ($10 Labs / Adult Vision / Rewards)
BlueSelect Silver 1456 ($50 PCP Visits / Rewards)
BlueSelect Silver 2343S ($40 PCP Visits / $80 Specialist Visits / Rewards)
Florida Blue HMO (a BlueCross BlueShield FL company)
BlueCare Bronze (HSA) 24K01-09 (Rewards / $4 Condition Care Rx)
BlueCare Bronze 24K01-03 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards)
BlueCare Bronze 24K01-05 (Rewards)
BlueCare Bronze 24K01-25 ($50 PCP Visits / $75 Specialist Visits / Rewards)
BlueCare Bronze 24K01-31S ($50 PCP Visits / Rewards)
BlueCare Bronze 24K02-17 (3 PCP Visits for $0 then $55 / $70 Specialist Visits / Rewards)
BlueCare Bronze 24K02-18 (Rewards)
BlueCare Bronze 24K02-23 ($50 PCP Visits / $75 Specialist Visits / Rewards)
BlueCare Bronze 24K02-26S ($50 PCP Visits / Rewards)
BlueCare Gold 24K01-08 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards)
BlueCare Gold 24K01-10 ($40 PCP Visits / $75 Specialist Visits / $15 Labs / Rewards)
BlueCare Gold 24K01-33S ($30 PCP Visits / $60 Specialist Visits / Rewards)
BlueCare Gold 24K02-20 ($0 Deductible / $15 PCP Visits / $75 Specialist Visits / $20 Labs / Rewards)
BlueCare Gold 24K02-28S ($30 PCP Visits / $60 Specialist Visits / Rewards)
BlueCare Platinum 24K01-04 ($0 Labs / $15 PCP Visits / $35 Specialist Visits / Rewards)
BlueCare Platinum 24K01-07 ($0 Deductible / $0 Labs / $15 PCP Visits / $25 Specialist Visits / Rewards)
BlueCare Platinum 24K01-34S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Rewards)
BlueCare Platinum 24K02-15 ($0 Deductible / $0 Labs / $15 PCP Visits / $25 Specialist Visits / Rewards)
BlueCare Platinum 24K02-29S ($0 Deductible / $10 PCP Visits / $20 Specialist Visits / Rewards)
BlueCare Silver 24K01-02 ($10 Labs / Rewards)
BlueCare Silver 24K01-06 ($50 PCP Visits / Rewards)
BlueCare Silver 24K01-32S ($40 PCP Visits / $80 Specialist Visits / Rewards)
BlueCare Silver 24K02-21 ($10 Labs / Rewards)
BlueCare Silver 24K02-27S ($40 PCP Visits / $80 Specialist Visits / Rewards)
HealthPartners
Atlas $1,300 Gold
Atlas $2,000 Standard Gold
Atlas $3,050 Plus Silver
Atlas $3,800 HSA Silver
Atlas $6,000 Standard Silver
Atlas $6,800 Plus Bronze HSA
Atlas $7,500 Standard Bronze HSA
Atlas $8,400 HSA Bronze
Medica
Medica with SSM Health Bronze $0 Copay PCP Visits
Medica with SSM Health Bronze Share
Medica with SSM Health Expanded Bronze Standard
Medica with SSM Health Gold $0 Copay PCP Visits
Medica with SSM Health Gold Share
Medica with SSM Health Gold Standard
Medica with SSM Health Silver $0 Copay PCP Visits
Medica with SSM Health Silver Share
Medica with SSM Health Silver Standard
Sanford Health Plan
Sanford Individual Simplicity $1,750
Sanford Individual Simplicity $10,600
Sanford Individual Simplicity $3,500
Sanford Individual Simplicity $4,750
Sanford Individual Simplicity $6,500
Sanford Individual Simplicity $7,200 HSA Qualified
Sanford Individual Simplicity Standardized $2,000
Sanford Individual Simplicity Standardized $6,000
Sanford Individual Simplicity Standardized $7,500
Sanford Individual TRUE $1,750
Sanford Individual TRUE $10,600
Sanford Individual TRUE $3,500
Sanford Individual TRUE $4,750
Sanford Individual TRUE $6,500
Sanford Individual TRUE $7,200 HSA Qualified
Sanford Individual TRUE Standardized $2,000
Sanford Individual TRUE Standardized $6,000
Sanford Individual TRUE Standardized $7,500
SummaCare
SummaCare Bronze 10600 with 3 Free PCP Visits + Adult Vision
SummaCare Bronze 10600 with 3 Free PCP Visits
SummaCare Bronze 8000 with Adult Vision Exam
SummaCare Bronze 8000
SummaCare Gold 1000 with 3 Free PCP Visits + Adult Vision
SummaCare Gold 2000 with 3 Free PCP Visits + Adult Vision
SummaCare Gold 2000 with 3 Free PCP Visits
SummaCare Silver 3500 with 3 Free PCP Visits + Adult Vision
SummaCare Silver 5000 1000 Rx with 3 Free PCP Visits
SummaCare Silver 6000 with 3 Free PCP Visits + Adult Vision
SummaCare Silver 7000 with 3 Free PCP Visits
SummaCare Standard Bronze with Adult Vision
SummaCare Standard Bronze
SummaCare Standard Gold with Adult Vision
SummaCare Standard Gold
SummaCare Standard Silver with Adult Vision
SummaCare Standard Silver
Coverage Questions FAQs
Common questions about this provider’s insurance participation, answered from the CMS Health Insurance Marketplace and Medicare enrollment files.
What insurance does MCDOWELLS PHARMACY INC accept?
Marketplace files for the 2026 plan year list MCDOWELLS PHARMACY INC as in-network for 1,004 plans from 17 insurance companies. The largest networks are Blue Cross and Blue Shield of Nebraska (38 plans), Florida Blue (BlueCross BlueShield FL) (33 plans), Dean Health Plan (27 plans), followed by 14 more companies. The full list above shows each plan's metal level, network type, and plan IDs.
Is MCDOWELLS PHARMACY INC enrolled in Medicare?
The CMS Medicare enrollment files linked to this NPI do not currently show a Medicare assignment or PECOS enrollment indicator. Registry files can lag recent enrollment changes, so verify Medicare participation directly with the practice.
What network types does MCDOWELLS PHARMACY INC participate in?
The accepted plans include 121 HMO plans, 107 PPO plans, 70 EPO plans and 33 POS plans. HMO (Health Maintenance Organization) plans cover care from network providers and typically require a primary care referral for specialists. PPO (Preferred Provider Organization) plans cover out-of-network care at a higher cost and do not require referrals. EPO (Exclusive Provider Organization) plans cover network providers only, generally without referral requirements. POS (Point of Service) plans combine HMO-style referrals with partial out-of-network coverage.
Where does this insurance data come from and how current is it?
Plan participation is compiled from the official CMS Health Insurance Marketplace public use files for the 2026 plan year and refreshed as CMS publishes updated files. Networks change during the year, so always verify coverage with the insurance company or the provider's office before scheduling care.
