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Understanding Your New Health Plan: HMO

For many, it’s a new benefit year. If your insurance provider, type of coverage, and/or details of your plan has changed, now is the time to review. Understanding your network, out-of-pocket expenses, and plan processes can help you save time and money.

For those who already have, or going to have, an HMO, we’ve put together a breakdown of general features and tips to help you navigate your coverage. Let’s get started!

Using Your HMO Effectively

An HMO (Health Maintenance Organization) offers its members a network of providers and facilities for their health needs. That means you have a group of contracted doctors, specialists, hospitals, clinics, etc. that you can visit under the terms of your plan.

With HMOs, these networks are usually smaller but important, since HMOs typically don’t provide an out-of-network benefit.

With most HMOs  – even ones that are employer-sponsored – you’ll be responsible for at least 4 out-of-pocket costs:

  1. Premium: The monthly amount you pay for your health coverage.

  2. Deductible: The annual amount you pay before your insurance kicks in.

  3. Copays: Set dollar amount you pay for a specific healthcare service.

  4. Reminder! Your copays do not go towards your annual deductible.

  5. Coinsurance: a set percentage you pay for covered services after your annual deductible has been met.

Have a Question About Your HMO?

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