AHIP Practice Exam

A 'network tier' in healthcare plans refers to levels of cost-sharing for providers. This concept is common in many managed care plans, such as Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs).

Healthcare plans often categorize providers into different tiers based on their agreements with the insurance company. Typically, providers in the lower tiers—those considered "in-network"—offer lower out-of-pocket costs for patients. Conversely, providers in higher tiers may have higher cost-sharing requirements, meaning patients would pay more when seeing those providers. This tiered approach encourages patients to seek care from those providers who have agreed to lower rates, helping to manage healthcare costs for both the insurer and the insured.

Contextually, the other choices do not accurately define the concept of a network tier. Levels of coverage in different states involve geographical variations, while categories of medical specialists pertain to specific types of doctors, and types of insurance policies available relate to the general classification of insurance products, none of which capture the cost-sharing structure associated with network tiers.