HMO Costs
HMOs are usually the least expensive kind of health plan. Costs vary, depending on where you live and the plan you have. A plan you buy on your own usually costs more, depending on your age and health.
Ask your employer or plan for a summary of your costs. Use this worksheet to list them.
| Costs: What's What |
premium |
The fee an HMO charges each month to maintain your coverage.
- The total premium is what you pay PLUS what your employer pays.
|
co-pay |
The flat fee that you pay each time you see a doctor or get services.
- Doctor visits, prescription drugs, emergency room visits, and hospital stays have different co-pays.
|
co-insurance |
Some HMOs charge you a co-insurance instead of a co-pay. The co-insurance is a percent of the cost of a service. |
yearly deductible |
Some HMOs have a yearly deductible. This is the amount you must pay each year to providers before your HMO pays anything.
- The yearly deductible does not apply to preventive services. From the beginning of the year, you only pay the co-pay for preventive checkups, family planning services, maternity/prenatal care, and some other services.
- You may pay a separate yearly deductible for prescription drugs.
|
out-of-pocket maximum |
This is the total you have to pay each year for most of your services.
- However, you still pay co-pays for some services, including prescription drugs and most medical equipment, even after you meet your yearly maximum.
|
hospital costs |
If you have a co-pay for a hospital stay, it can be several hundred dollars.
- If you pay a co-insurance, you pay a percent of the hospital costs. This can be very expensive.
- Learn more about hospital costs.
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