HMO Guide for Seniors - Office of the Patient Advocate - State of ...

12 Paying for a Medicare HMO
I
f you join a Medicare HMO, you still pay your Part B premium
to Medicare. You also pay a monthly premium to your HMO.
Medicare HMOs can change fees and benefits once a year. They
must tell you ahead of time, so you can change plans if you want to.
Ask your Medicare HMO about these costs:
What is the monthly premium?
Do you pay any deductibles? This is the amount you pay for
services before your plan starts to pay.
Do you pay a flat fee (called a co-pay) or a percent of the cost
(called co-insurance) when you get a service?
What is your co-pay or co-insurance for doctor visits, hospital
stays, emergency room visits, and other services?
Is there a limit to your yearly out-of-pocket costs? If your costs are
so high that you reach the “yearly out-of-pocket maximum,” your
HMO will cover most of your costs for the rest of the year.
You are usually
charged a flat fee,
called a co-pay,
for each doctor
visit.
Medicare HMOs do not pay all your health care costs.
Some services, such as nursing home care, are
limited. You may have to pay high co-pays
or deductibles for some care, like nursing
home and hospital care.
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