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Self-Employed HMO Health Insurance

If you are self-employed, you may be looking to save on insurance costs. Choosing an individual health maintenance organization (HMO) type of health plan is economical. HMOs are generally the least expensive managed-care plan and offer a full range of health benefits. You should be sure your doctors belong to the HMO's provider network, as you will be limited to seeking care from doctors within the network.

  1. HMO Concept

    • A broad goal of HMOs is reducing health care expenses by focusing on preventive care. HMOs promote routine and wellness visits to avoid more costly care later. HMOs require that you select a primary care provider who will direct all your care. Your name goes on a list sent to the providers monthly so they know who is enrolled in the HMO and has selected them as a provider. Providers are paid a monthly fee, called capitation, for each patient on this list.

    HMO Advantages

    • HMOs have many advantages over other types of health insurance plans. HMOs are typically lower in out-of-pocket costs. The monthly premium is low, and you will not incur deductibles and maximums as you would with other plan types. Many HMOs waive co-payments or have small co-payment amounts. HMOs encourage preventive care and often offer routine care at no extra cost to the subscriber. Because services are considered scheduled, you know your portion of the cost sharing before receiving services.

    HMO Limitations

    • The biggest disadvantage to having an HMO is the inflexibility of the plan design. You must select a primary care provider (PCP) who directs all your care. Your PCP provides you with referrals to specialists, and you must follow this path or the HMO will not cover your care. You must stay within the HMO provider network, and if you go outside it to seek care, except in emergency circumstances, your services will not be covered. You will be responsible for paying any incurred bills from out-of-network providers.

    Finding Individual HMOs

    • Finding an HMO for you and your family is not difficult. You can choose to work with a health insurance agent who will help you with the process. An agent will research insurers, obtain quotes, provide you with the application and deliver the policy to you. You can also choose to contact insurers directly to compare plans, obtain quotes and apply. Most carriers allow you to do all of this through their websites.

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