Elizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Elizabeth Rivelli Insurance WriterElizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Written By Elizabeth Rivelli Insurance WriterElizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Elizabeth Rivelli Insurance WriterElizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, s.
Insurance Writer Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
Les Masterson Deputy Editor, InsuranceLes Masterson is a deputy editor and insurance analyst at Forbes Advisor. He has been a journalist, reporter, editor and content creator for more than 25 years. He has covered insurance for a decade, including auto, home, life and health. Before cove.
| Deputy Editor, Insurance
Updated: Feb 21, 2024, 4:52am
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Health insurance is not a one-size-fits-all, and there are several types of health insurance plans to choose from. They vary in terms of cost, coverage, rules and network size.
One of the most common types of health insurance is an HMO, which stands for health maintenance organization. HMOs are known for being one of the most affordable health insurance plans, but they don’t offer the flexibility found in other plans.
An HMO is a health insurance plan that contracts with a network of physicians, hospitals and medical specialists. An HMO plan covers only the cost of medical services involving an in-network doctor or hospital, except for emergency care.
HMOs typically require that you work with a primary care physician who coordinates your care. HMOs generally require a referral from your primary care doctor if you need to see a specialist, like a dermatologist or cardiologist.
There are a few ways to purchase an HMO health insurance plan:
HMO plans cover the cost of medical care when you visit an in-network provider. Doctors and hospitals in the HMO’s network agree to accept a certain payment for services, which is why HMO premiums are more affordable than other plans.
When you receive care in-network, your health insurance company covers a certain percentage of the cost. You pay the rest in the form of out-of-pocket costs, such as a health insurance deductible, copayment or coinsurance (depending on your specific plan).
It’s important to know that HMO plans don’t provide coverage for out-of-network care. If you choose to see a doctor or visit a hospital that isn’t in the HMO’s provider network, you’re responsible for the full medical bill unless you’re receiving emergency or urgent care. Out-of-network care costs also don’t usually go toward your plan’s annual deductible.
The average monthly cost of an HMO on the ACA marketplace is $390 for single coverage for a 30-year-old, $438 for a 40-year old, $613 for a 50-year-old and $930 for a 60-year-old.
The cost of an HMO plan depends on a few factors. If you purchase coverage through the ACA marketplace or enroll in an individual plan through a private health insurer, some of the things that will impact your health insurance premium include:
| Health insurance plan member | Average monthly cost for an HMO plan |
|---|---|
| Child age 0-14 | $261 |
| Child age 18 | $309 |
| Adult individual age 21 | $342 |
| Adult individual age 27 | $361 |
| Adult individual age 30 | $390 |
| Adult individual age 40 | $438 |
| Adult individual age 50 | $613 |
| Adult individual age 60 | $930 |
| Couple age 21 | $684 |
| Couple age 30 | $780 |
| Couple age 40 | $877 |
| Couple age 50 | $1,226 |
| Couple age 60 | $1,859 |
| Couple+1 child, age 21 | $944 |
| Couple+1 child, age 30 | $1,040 |
| Couple+1 child, age 40 | $1,137 |
| Couple+1 child, age 50 | $1,487 |
| Couple+2 children, age 21 | $1,205 |
| Couple+2 children, age 30 | $1,301 |
| Couple+2 children, age 40 | $1,398 |
| Couple+2 children, age 50 | $1,747 |
| Couple+3 or more children, age 21 | $1,466 |
| Couple+3 or more children, age 30 | $1,562 |
| Couple+3 or more children, age 40 | $1,659 |
| Couple+3 or more children, age 50 | $2,008 |
| Individual+1 child, age 21 | $603 |
| Individual+1 child, age 30 | $651 |
| Individual+1 child, age 40 | $699 |
| Individual+1 child, age 50 | $874 |
| Individual+2 children, age 21 | $863 |
| Individual+2 children, age 30 | $911 |
| Individual+2 children, age 40 | $960 |
| Individual+2 children, age 50 | $1,134 |
| Individual+3 or more children, age 21 | $1,124 |
| Individual+3 or more children, age 30 | $1,172 |
| Individual+3 or more children, age 40 | $1,221 |
| Individual+3 or more children, age 50 | $1,395 |
| Source: Healthcare.gov. Based on unsubsidized ACA plans. | |
Enrolling in an HMO through your employer’s group health insurance will usually cost less trhan buying an individual or family health plan on your own. Group health insurance premiums are subsidized by employers, lowering the amount of money that comes from your paycheck.
Employees paid an average of $108 per month for single coverage and $497 per month for family coverage in an employer-sponsored health plan in 2021, according to the Kaiser Family Foundation.
While HMO health insurance plans have benefits like lower premiums, they have some drawbacks. Before you purchase an HMO plan, it’s a good idea to review the pros and cons of this type of health insurance plan.
Preferred provider organization (PPO) health insurance allows you to get coverage in-network or out-of-network. Out-of-network care usually costs more, though. Your health plan pays the largest share of the cost when you visit an in-network provider, and a smaller portion when you go out of network.
Another difference between PPO and HMO plans is that PPO plans don’t require members to work with a primary care physician, and referrals to specialists aren’t required. But PPOs typically have higher premiums due to the flexibility this type of plan provides.
An EPO health insurance plan, which stands for exclusive provider organization, is similar to an HMO.
Like an HMO, EPO plans provide coverage for in-network care exclusively. Your insurance company will only cover the cost of medical services if you visit a provider or hospital in the EPO’s network. Out-of-network medical care is only covered in the event of an emergency.
Some EPOs require you to work with a primary care physician and get referrals to see a specialist, but it depends on the specific plan.
One of the biggest differences between HMOs and EPOs is the network size. EPO health insurance plans generally contract with a larger network of doctors and hospitals, giving you more options. As a result, EPO plans are usually more expensive than HMO plans.
If you’re considering an HMO but want a larger selection of providers, a point of service (POS) plan might be the right choice for you if you have that option.
POS plans share similarities with HMOs and PPOs. Like an HMO, POS plans require you to work with a primary care provider and get a referral to visit specialists. But you’re allowed to see providers that are in-network and out-of-network, like a PPO.
When you get medical treatment under a POS, your health insurance company pays the largest portion of the bill when you go in-network. A smaller portion of the cost is covered when you go out-of-network, and the rest you pay in the form of a health insurance deductible or coinsurance.
Because POS plans provide more choices than an HMO but less freedom than a PPO, the cost ends up somewhere in the middle. POS premiums are generally more expensive than an HMO, but less expensive than a PPO.
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Insurance WriterElizabeth Rivelli has nearly five years of experience covering insurance for finance publications. She has expertise in various insurance lines, including car insurance, health insurance, travel insurance, life insurance and others. In her writing, she aims to make insurance more approachable and understandable for people in all stages of life. Elizabeth also writes for several insurance company blogs.
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