Hmo Hypothesis Paper

The HMO deductible is the amount you have to pay toward your actual medical

bills before your insurance policy starts paying out. For example, an HMO policy with a

$1,000 deductible requires you to pay the first $1,000 of your medical bills; then your

coverage will start ( Premiums and Deductibles, 2007). When you have a higher

deductible, you typically get a lower premium. The co-payment or "copay," is a

fixed-dollar amount that you have to pay each time you get healthcare services. In HMO

plans, the copay for a doctor visit is often as low as $10. Most HMOs reimburse 80

percent of covered allowable expenses after the annual deductible of $250 to $500 per

person or $750 per family has been met (Medical and Dental Plans, 2007). The maximum

out-of-pocket expenses per calendar year for most HMO plans are $1,000 per participant

and $2,000 per family (Premiums and Deductibles, 2007).

HMO Prescription Drug Plans normally includes a $5 co-pay for generic

prescriptions and a $13 co-pay for name brand medications. HMO Dental pays preventive

care at 100 percent of usual and customary charges with no deductible. Preventive care

covers two cleanings per year, bitewing x-rays once a year, and full-mouth x-rays every 3

years. Restorative services,