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Home > Health Insurance Basics > Health Care Costs > HMO Costs

HMO Costs

HMOs are usually the least expensive kind of health plan. Costs vary, depending on where you live and the plan you have. Beginning in 2014, plans cannot charge you more because you have a health problem or are pregnant.

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 charges.

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