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Networks Explained

What Is MagnaCare, and How Does Out of Network Coverage Actually Work?

Written and reviewed by Dick Tracy, licensed health insurance broker (NPN 20414610) · Published September 21, 2026

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Quick answer MagnaCare is a provider network, not an insurance company. It is the regional network for New York and New Jersey, and PHCS and MultiPlan act as the nationwide wraparound when your care leaves those two states. On the plans I place through a pre-established ERISA group, going out of network is your normal copay structure plus 10 percent coinsurance, and there is one single deductible that counts the same in network or out. A typical PPO does not work that way. It usually starts a second, higher out of network deductible at zero and then splits the bill 50/50 or 70/30 on top of it. Once you know that providers contract with networks and not with insurance companies, most of the confusion at the front desk disappears.

I'm Dick Tracy, an independent health insurance broker in Western New York, licensed in 25 states with 80+ carriers behind me. This question comes up on my calls constantly, usually in a slightly panicked voice: the office just said "we don't take that." I came out of the healthcare side of this business, so there is no gag clause on me, and I will give you the tips, the tricks, and the traps. Here is the part almost nobody explains before you need it.

What is MagnaCare? Providers contract with networks, not with insurance companies

MagnaCare is a network. That is the whole definition, and it is the piece that trips people up. A network is a list of hospitals, physician groups, labs and imaging centers that have signed a contract agreeing to accept a set price for a service. MagnaCare is the network that covers New York and New Jersey. It does not collect your premium, it does not issue your policy, and it does not decide your claim. It is the price list and the roster of who agreed to it.

That is also why the name on your ID card and the name of your network are frequently two different things, and why nobody at the front desk seems to know what you have. They are looking for a carrier logo. You are on a network. Two different questions, and the wrong one gets asked about nine times out of ten.

This is the sentence to keep. Your doctor did not sign a contract with an insurance company. Your doctor signed a contract with a network, and insurance plans rent access to that network. One provider can sit inside four or five networks at once and be "in network" for plans from carriers they have never heard of.

So when the receptionist says "we don't take that insurance," she is usually telling you the truth about the wrong thing. She checked the carrier name. She did not check MagnaCare, and she did not check PHCS or MultiPlan. Ask her to look up the network name printed on the card instead, and a good share of those conversations end with "oh, we do take that." I have had that exact call more times than I can count, and it is the single cheapest thing you can learn about your own coverage.

Out of network on these plans: your copay plus 10 percent, one deductible

Here is the structure people call me to double check, because it does not sound like what they are used to. On the plans I place through a pre-established ERISA group, out of network runs your normal copay structure plus 10 percent coinsurance. And there is one deductible. Not an in network deductible and a separate out of network deductible. One number, and every dollar you spend counts toward it no matter which side of the network line the care happened on.

Now put a standard PPO next to it. On a typical PPO, the out of network deductible is its own number, it is higher than the in network deductible, and it starts at zero in January regardless of what you have already paid in network. After you satisfy it, the plan pays somewhere in the neighborhood of 50 or 70 percent of an allowed amount and you carry the rest. That is the difference between a 10 percent haircut and a coin flip. If your in network deductible is met in March and you end up somewhere out of network in July, one of those designs treats you like you already paid and the other one treats you like you just walked in the door.

I am not going to tell you every plan with a MagnaCare logo on it behaves identically, because that is not true and you should be suspicious of anyone who says it. Get the deductible, the coinsurance and the out of pocket maximum, in network and out of network, in writing on the specific plan you are being offered. If the person selling it dodges that question, that is your answer about the person.

Traveling or out of state: where PHCS and MultiPlan pick it up

The second half of the question is always some version of "what happens when I am not in New York." A kid at school in another state, a parent in Florida for the winter, a specialist at a hospital system across the state line. This is where the national wraparound matters. MagnaCare covers New York and New Jersey, and PHCS and MultiPlan carry the rest of the country, so care in another state is generally handled inside the network instead of landing as an out of network claim.

Compare that to a plan built around one regional hospital system, which is what a lot of people in Western New York are carrying without realizing it. Those plans are excellent right up until the moment you cross a county line, and then the map runs out. A true PPO on a national network is the difference between "we will cover that" and "you should probably drive home first."

Before a planned procedure out of state, have the facility verify against PHCS or MultiPlan specifically, by name. And if it turns out they are not on either list, you are not uncovered. You are at your copay plus 10 percent, which is a very different sentence than the one people brace for.

What to do when the front desk says you are out of network

Run this in order. One, ask which network they checked, and give them the network name off your card rather than the carrier name. Two, if they still say no, ask them to check the other one: MagnaCare for New York and New Jersey, PHCS or MultiPlan nationally. Three, if the provider genuinely is not in either network, call me before the appointment, not after the bill, because the out of network math is worth knowing in advance and there is often an in network option nearby you did not know about. Four, if a bill already landed, do not pay it off the first piece of paper. Compare it against the Explanation of Benefits, because the EOB is the document that tells you what you actually owe, and the bill is frequently the document that tells you what somebody hopes you will pay.

Who is this network structure not for? Somebody whose care is locked to one specific out of state hospital system that neither MagnaCare nor PHCS and MultiPlan holds. If you are in active treatment at a named center and that center is not on either list, a wider national network is not going to fix that, and I would rather tell you so in the first five minutes than sell you around it. That is a real limit and it is worth checking before anything else. For most people, though, the honest answer is that the network is wider than what they have now, not narrower.

Why this comes up so often in New York

New York is a community rated state, which means being healthy earns you nothing on an individual plan here, and the plans available to most people are built around regional networks. That is the backdrop for almost every one of these calls.

The route I open first for a healthy New Yorker is a pre-established ERISA group plan. Federal ERISA law from 1974 overrides New York's community rating, so a solo owner or a family can be merged into an existing group: group rates instead of community rates, a true PPO on MagnaCare in New York and New Jersey or PHCS and MultiPlan nationwide, and a policy that you own and keep rather than one an employer owns. No payroll and no employees required, and entry is a simple compliance step I walk you through. The full explanation of how that works is here.

It is not the answer for everybody. It runs on health questions, so it is not the door for a household that cannot pass them, and a serious diagnosis inside the last five years belongs on a no-questions marketplace plan for now. The marketplace is one tool with real trade-offs of its own: county by county networks, community rating, a subsidy that runs on an income guess and can be clawed back at tax time, and the 2026 cliff at 400 percent of the federal poverty level. If your income is genuinely low and the premium tax credit is large, that may honestly be your best deal, and I will tell you that too. If you are near the income line and want to see where you land, check the free 2026 subsidy cliff calculator. Either way the right move is to see the options side by side. I educate, you decide.

Common questions about MagnaCare and out of network coverage