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Enter your income, state, entity and current cost.
PPO coverage
Self-employed and stuck in an HMO you did not really choose
Almost nobody picks an HMO because they want one. They pick it because it was the version of coverage their budget reached on the individual market. Then they discover what it means in practice.
Hidden cost
What it actually costs you.
A referral before you can see a specialist. A provider list that is shorter than you expected, and a phone call every time you need to check it. Coverage that gets complicated the moment you leave your region, which matters if you travel for work, split time between states, or have family elsewhere.
None of that appears on the current cost line. It shows up the first time you need the plan to do something.
Blocked upgrade
Why upgrading usually is not offered to you.
Broad network PPO coverage at a sensible cost is a group product. Individuals buying alone are confirmed individual rates, and at those rates the PPO option is often not realistic.
So the choice you are given is not PPO versus HMO. It is an expensive HMO or a more expensive HMO.
Group structure
What being inside a group changes.
Group coverage requires an employer and an employee. Through a co-employment structure the owner becomes a W-2 employee of the co-employer, and coverage comes from an established group master plan. That is what puts a group-plan path within reach for a company of one.
Specialists without a referral. A network that works in any state. A far better chance your existing doctors are already in it, though you should check rather than assume.
The licensed provider decides whether you can enroll. Nobody can promise that in advance.
Renewals
On renewals.
The other reason owners look is not this year's cost, it is the pattern of increases. Individual market cost and group master plan cost do not respond to the same pressures.
We will not tell you your cost is fixed, because the licensed provider governs that, and anyone who promises otherwise is selling. It is a different structure to sit inside and that is worth understanding before your next renewal.
Calculator first
Whether the upgrade is worth it for you.
Remove what does not fit
The calculator eliminates what you do not qualify for and shows what is left.
Keep the better position
If your current plan is the better position, it says so.
Objections
The questions PPO shoppers ask first.
A PPO costs more than an HMO.
As individual policies, generally yes. That comparison is not the one this page is about. The relevant comparison is individual HMO against group PPO.
I never get sick, so the network does not matter.
Until it does. That is a real bet some people are comfortable making, and it is worth making deliberately.
My HMO covers my doctor.
Then check the network difference anyway, particularly for specialists and out of area care.
I would rather just pay less.
Reasonable. Run the number, because sometimes better coverage and a better annual position are not in conflict.
FAQ
Self-employed PPO coverage questions.
You did not choose the HMO. Find out what the alternative actually costs you.