Understand your costs

You deserve high-quality care and services — not financial surprises. Here’s what you need to know to understand your costs better.

How an HMO plan works

With an HMO plan, you get predictable costs for care and no deductibles. You’ll know from the start how much your copays or coinsurance are for services and prescriptions.

How much you pay for care

For certain services covered by your plan, you’ll pay a set amount — a copay. For other services, you’ll pay a percentage of the charges — a coinsurance. Kaiser Permanente covers the rest, and you won’t have to meet a deductible first.

You’ll get most preventive care at no cost or a copay — and if you reach your out-of-pocket maximum, you won’t pay for covered services for the rest of the year.* 

How much your family pays for care

If your family is covered under your plan, you also have a family out-of-pocket maximum. If you reach it, no one in your family will pay for most covered services for the rest of the year.

Before you reach your family out-of-pocket maximum, your family’s individual out-of-pocket maximums still apply. If any family members reach their individual out-of-pocket maximum before the rest of the family, those members won’t have to pay for most covered services for the rest of the year.

Estimate your costs

Our cost estimates tool can help you plan for health care costs ahead of time. Your estimates are based on your plan details and how much you’ve paid toward your out-of-pocket maximum — so you get personalized information every time.

To learn more about your plan, you can:

• Sign in to your account and click “Coverage & Costs” 
• Call the number on your medical bill or Kaiser Permanente ID card

What to expect at your visit

You may be asked to pay before, during, or after your visit. Here’s what you can usually expect:

• When you check in, you’ll be asked to make a payment for most scheduled services.
• During your visit, you might get services you didn’t schedule, like X-rays or blood tests. These could have extra costs.
• After your visit, you’ll get a bill if the total cost of your care is more than what you paid at your visit.

If you need help paying your bill, we offer payment plans and financial assistance.

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