Personal Finance Tips

Health Maintenance Organizations (also widely referred to as HMOs) is a variation of health benefits distribution, which provides coverage on a fee-for-service basis. Insurance companies that provide HMO coverage plans each have an agreement with certain medical facilities and professionals in order to offer reduced fees to those, who purchase such plans.

What HMO plans are all about?

HMO plans are based around primary care physicians (PCPs) that a person buying such a plan has to choose from the network of medical providers the company works with. The PCP is the person who will manage and coordinate all the actions and services provided to the customer, as well as offer consulting and basic care measures such as check ups and exams. Preventive medical services are usually free of copayments within HMO plans.

In case the health problem of a person exceeds the professional field of knowledge of the PCP, the doctor refers this patient to another physician specialized in that very domain. The said specialist will further investigate the problem and use his expertise to resolve it, but only after he or she receives the referral from the PCP. Otherwise, you won’t be able to receive any medical attention with the exception of situations of critical emergency when the risk of complications is very high.

The coverage you receive through an HMO plan is provided only within the limits of the medical network specified by your provider. In case the member of an HMO plan chooses to receive any medical services in a facility that doesn’t make part of the network, there won’t be any coverage and the person will cover all the expenses in full out of own pocket. Besides, HMO plans will allow you to receive medical care from an additional specialist only when you have the corresponding referral provided by your PCP. Otherwise, this is regarded as using out of network services and your expenses won’t be covered at all even if it’s the same medical facility where your PCP is located.

Why would you want to choose an HMO health insurance plan?

HMOs represent the most affordable and cheap health insurance amongst managed care options. If comparing the rates of POS or PPO, HMOs offer lower premiums and fewer copayments. This is why many employees choose HMOs as the type of group insurance plans for their workers. This is especially useful for those, who rarely visit a doctor and don’t need an extensive medical care with their plan or don’t have pre-existing conditions that they want to cover. Employers find these plans useful because they can cut their costs and provide additional benefits to their workers rather than paying only for health insurance.

If you are worried by the constant trend of medical costs and insurance rates rising every year, it’s highly recommended to see if an HMO plan meets your insurance requirements. Get health insurance quotes from multiple providers and you will definitely find a good plan for a reasonable and competitive price. However, if you have more specific insurance needs and can spend additional money on extensive coverage, it’s better that you investigate other plan options outside HMOs.

Health insurance spendings account for a large part of business activity costs, and their share is especially large with small businesses and home-based enterprises. And with the continuous trends in rates increase it’s getting harder and harder for small enterprises to carry this burden, causing many small businesses to drop health coverage benefits altogether.

A recent study conducted by the Commonwealth Fund in New York has concluded that small businesses tend to pay 18% more for health insurance than their larger counterparts all across the country. That’s because large enterprises have a better negotiating power due to larger numbers of workers to be insured. Having that in mind, being despaired about the thing won’t help your small business much. About 60% of 46 million people in the US who have no health insurance coverage are employed by small enterprises and these numbers keep on growing. Such tendencies are no good news for small businesses, because qualified and better workers tend to pay much attention to health benefits at the enterprise and not having them lowers your chance of attracting workers who will help develop your business better.

In order to cope with the Catch 22 situation here, you have to learn how to minimize your healthcare costs and provide your employees with the benefits they deserve. Here are some tips on how to get exactly what you need:

1. Keep the workers healthy. Instead of fighting the consequences and paying for costly medical coverage, you can invest into your workers’ health and promote different wellness programs at your business. Introduce regular screenings, check-ups and promote a healthy lifestyle by offering your employees free gym sessions or other benefits. It’s much easier to prevent a disease rather than treat it.

2. Lower the coverage. Larger coverage amounts lead to higher premiums and a logical solution for this would be lowering the coverage. You can also ask your employees to partially contribute to the premiums if they want to keep the initial coverage amounts. Of course, this would be quite unpopular among your employees but if your small business insurance plan is in question you have to consider going with such unpopular measures.

3. Think about HSAs. Health savings accounts are gaining popularity amongst small business owners as they provide more flexibility and tax benefits than typical health insurance options. HSAs combine high-deductible health insurance plans with tax-free savings accounts, making the premiums you have to pay lower, and providing more saving options to your employees. And the fact that all withdrawals are tax-free makes it a great option for those who want to get great small business insurance health coverage without constraining the enterprise’s budget.

4. Team up with other small businesses. You can join an association or buying union who other local small businesses in order to gain better rates. Such associations provide small enterprises the bargain power of big companies because when combined, such groups have a large number of employees to be insured which eventually leads to more competitive premiums compared to going off alone. Member fees are usually quite low with such groups while the benefits are great, so think about joining one of you have in your area. This might give you good rates on other forms of small business insurance as well.