HMO Costs

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.