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Health insurance is a critical factor for small businesses to help retain and recruit employees and sustain productivity and satisfaction. UnitedHealthcare offers a range of group health insurance options designed to help your small business save money and support your employees’ health and well-being.

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Simply complete a quick form to get started with a quote for your small business. A UnitedHealthcare representative will get in touch and work with you to help find group health insurance options that best fit your business.

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To get more details on health insurance options for your small business, click on your state below. In markets where the Small Business Store is available, 1 you will be directed there. In markets where the Small Business Store is not available, you can request a quote from UnitedHealthcare.

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For companies with 51 or more employees

Find the right medical plans for your employees and your business, plus supplemental plans for dental, vision, disability and more.

Explore products and solutions for small businesses

There's not just one way we work to help small businesses like yours. By offering benefits packages designed to improve employee experience and help employers manage cost, there's a number of products and solutions that may be right for your business.

Explore a range of group health plans and network options.

Discover how integrated pharmacy benefits from OptumRx may help lower costs for you and your employees.

Enhance your employees’ specialty benefits package with vision, dental, financial protection plans and more.

See how we are guiding employees to the behavioral care they need.

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Find information to help you and your employees get the most from their health benefits.

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UnitedHealthcare’s employer-sponsored insurance plans serve groups that fall into three categories: Small Group plans refer to employers with up to 100 employees; Key Accounts is for employers with 101 to 5,000 employees; and National Accounts serves employers with more than 5,000 employees.

Building healthier workplaces together

A small business with about 40 employees shares why working with UnitedHealthcare has enabled them to provide a health plan that delivers on what matters to their employees.

Video transcript

Instrumental music plays throughout. Three white lines curl across a blue background. Blue text centers a white screen.

ONSCREEN TEXT:          Building healthier workplaces together

Upbeat music plays to a montage of shots from employees working in warehouse, a forklift, a man outside, seed being filled into a bag, a white truck driving through plains, and a blonde-haired woman smiling.

The screen dissolves into white with the blue United U logo appearing in the center.

Inspirational music begins playing as we see an aerial view of the Albert Lea Seed Plant. The scene switches to an aerial view of a baseball field, then to the Albert Lea Seed Plant entrance. The view moves inside where Matt Helgeson speaks to a circle of employees in the warehouse.

MATT: Okay, good morning, everybody.

We've got trucks at the dock today, so it's going to be a busy Monday.

We've got trucks on the scale as well, so we'll need a couple samples pulled up.

The screen shows Matt being interviewed before a white background.

MATT: Albert Lea Seed has been in business for almost 100 years,

A blue bar slides into the bottom left of the screen, containing white text.

ONSCREEN TEXT:          Matt Helgeson Owner, Albert Lea Seed

MATT: and today our focus is distributing seed throughout the Upper Midwest and throughout the country.

A white text box with the Albert Lea Seed logo scrolls down from the top left of the screen.

ONSCREEN TEXT:          Organization Albert Lea Seed 

Location Albert Lea, MN

Industry Agriculture

Established 1923

Number of employees 40

Music continues. We see Matt checking seed and then a man pouring seed into a bag in a warehouse.

Matt: One of our key focuses is distributing an organic and non-GMO seed to farmers who are under those production methods.

We see Matt and another man examining seeds in a field.

MATT: Many of our seeds that we offer here are produced by local farmers.

Those seeds include soybeans especially, and also small grains; things like oats, wheat, barley, and rye.

We see palettes of bags of organic grain seed and barley. Scene cuts to a white truck driving on a dirt road in the fields.

MATT: Those relationships with our customers matter to us, and they matter to the farmer, and so we try to offer honest advice and seeds in which the quality we believe is truly there.

Matt gets out of truck and shakes hands with another man in a field. Matt and a man inspecting crop.

Nicole Hansen begins speaking. We see the Albert Lea Seed building sign, then Nicole speaking to employees in the warehouse, handing out open enrollment booklets. A white UnitedHealthcare U logo is at the bottom right corner of the screen

NICOLE: Good morning, everyone. I'm going to briefly talk to you guys this morning about open enrollment for 2022. I'm going to hand out some booklets for everyone.

The screen changes to Nicole Hansen interviewing before a white background. A blue bar slides into the bottom left of the screen, containing white text.

ONSCREEN TEXT:        Nicole Hansen Human Resources, Albert Lea Seed

NICOLE: A lot of people are surprised to hear that the Albert Lea Seed House even offers benefits just because we're such a small employer and we're not actually required to offer any type of health insurance.

Nicole continues speaking while we see a montage of a forklift in the warehouse.

NICOLE: We want the best for our staff and for their families. We take a lot of pride in not having high turnover rates, and that's because of how we treat our employees and how comfortable they feel with us.

The screen switches back to Nicole in front of a white background.

NICOLE: We meet with our broker every year, the controller and I do, and we're always looking at a plan that's going to impact our staff in the most positive way.

Nicole continues speaking while we see a montage of employees working with seed in the warehouse.

NICOLE: Which one is going to cover them is depending on what's going on in their life and make a positive impact on them and their families.

Matt begins speaking and we see a montage of workers in the warehouse.

Matt: The health of our employees is critically important.

The screen changes to Matt being interviewed in front of a white background.

MATT: The UnitedHealthcare plan has been very beneficial for all of our employees here.

While Matt is speaking, we now see a montage of employees at work and the white UnitedHealthcare U logo in the bottom right corner.

MATT: The incentives for employees to improve their health and have more of a preventative concept is really important.

Nicole is speaking before a white background.

NICOLE: The incentive program that's offered through UnitedHealthcare is a huge success with all of my staff here.

While she is speaking, we see Nicole and Matt walking and talking outside.

NICOLE: They love the incentive for them to get up and get moving. It gives them a great feeling, and they love the extra cash flow into their HSA. These plans that we offer through UnitedHealthcare are very important to us because happier employees are more productive employees, which are healthier employees.

The screen is changing back to Nicole speaking in front of a white background

NICOLE: And that's exactly what we strive for here at the Albert Lea Seed House.

Blue text flashes quickly on screen, centering a white background.

ONSCREEN TEXT:        There

ONSCREEN TEXT:        for

ONSCREEN TEXT:        what

ONSCREEN TEXT:        matters

A blue u-shaped logo appears against a white background, followed by text.

ONSCREEN TEXT:        UnitedHealthcare

Small black text runs along the bottom of the screen.

ONSCREEN TEXT:        All trademarks are property of their respective owners.

ONSCREEN TEXT:        Insurance coverage provided by or through UnitedHealthcare Insurance Company or its affiliates. Administrative services provided by United HealthCare Services, Inc. or their affiliates.

ONSCREEN TEXT:        © 2023 United HealthCare Services, Inc. All Rights Reserved. 23-2747306

ONSCREEN TEXT:        EI232767439 11/23

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Are Small Businesses Required to Offer Health Insurance?

How small business health insurance works, benefits of offering health insurance as a small business, types of health insurance for small businesses, finding affordable small business health insurance, choosing the right health insurance plan for your small business, resources and support for small businesses, which businesses are eligible for the small business health options program (shop), how can small businesses find the right health insurance plan, how much does health insurance cost on average for a small business per employee, the bottom line.

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• Best Health Insurance Plans
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• How Social Security Works
• Save for Retirement
• SEP IRA Plan
• Individual 401(k) Plans
• Individual 401(k) vs. SEP IRA

Offering health insurance as a small business owner can yield tangible and intangible benefits. A good healthcare plan can be a strong incentive when attempting to attract top talent to your business. Employees may feel a deeper sense of job satisfaction in knowing they have healthcare benefits if they need to use them. Employers can also benefit in the form of tax breaks.

The challenge is finding the right healthcare option to offer to your employees.

Key Takeaways

• Small businesses face challenges in providing good, affordable healthcare coverage to their employees.
• The Small Business Health Options Program (SHOP) helps small businesses provide health coverage and offers benefits such as plan comparisons.
• Small businesses should consider factors like cost, coverage options, and employee needs when selecting a health insurance plan.
• Employer-sponsored insurance plans cater to the needs of small businesses and offer various benefits and considerations.
• Offering healthcare benefits can help you attract and retain talented employees, improve their satisfaction and productivity, and contribute to your business success.

Under provisions of the Employer Mandate of the Affordable Care Act (ACA) , businesses are required to offer health insurance only if they have 50 or more full-time employees or full-time equivalent (FTE) employees. If you meet that standard, you’re considered a large employer for Internal Revenue Service (IRS) purposes.

• A full-time employee is someone who averages at least 30 hours of service per week during the calendar month, or at least 130 hours during the calendar month.
• Full-time equivalent employees refer to a group of workers who may not all be employed full-time, but whose working hours combined are equivalent to a full-time employee.

Special rules for determining full-time employee status apply to businesses that hire seasonal workers.  

Independent contractors are not considered employees, so the ACA rules for health insurance don’t apply to them. A sole proprietor running a small business may be subject to the rules, but only if they meet the 50 or more full-time employees or FTE guidelines. Self-employed business owners with no employees can enroll in healthcare plans through the federal marketplace if they need coverage for themselves or their family members.  

Small businesses that are required to offer health insurance, or that voluntarily choose to do so, are obligated to offer coverage to 95% of full-time employees and their eligible family members. Again, a full-time employee is defined by thresholds of 30 hours per week or 130 hours per month. Businesses would need to have at least one eligible full-time employee to offer coverage.

Coverage must meet two standards to be aligned with ACA requirements:

• Minimum value . An employer-sponsored plan is determined to offer minimum value if it covers at least 60% of the total allowed cost of care for covered employees, and if its benefits include substantial coverage of physician and inpatient hospital services.
• Affordability . For 2024, workplace health insurance is deemed affordable if employees’ share of monthly premiums in the lowest-cost plan offered is less than 8.39% of household income .

Affordability is based on the premium that would cover all individuals in the employee’s household. Income is calculated based on the earnings of everyone in the household who is required to file a tax return. To qualify for a federal tax credit , employers must pay at least 50% of health insurance premiums for covered employees. Employers can, however, opt to pay a larger share of the premiums so that employees have less to pay out of pocket.

Businesses are required to offer health insurance to employees when they become eligible for it. Employers can impose a waiting period before employees are eligible. The maximum allowed waiting period is 90 days.

Employees can make changes to their plan if they qualify for a special enrollment period , which is triggered by a life change. For example, a covered employee who has a child would qualify for a special enrollment period to add a new baby to their plan. Employers must provide a special enrollment period of at least 30 days to employees who are eligible to change their plans.

Offering health insurance to your employees, whether you’re obligated to do so by ACA rules or not, can help your business and your workers in many ways. Here are some of the main advantages of including health insurance as part of an employee benefits package.

• Attract top talent . Job seekers may be more inclined to pursue career opportunities with businesses that offer attractive benefits, including health insurance.
• Increase retention . A good health insurance plan may be an incentive for employees to remain loyal to your business, rather than moving on to another company.
• Qualify for tax breaks . Eligible businesses can qualify for the small business healthcare tax credit , which is worth up to 50% of employer-paid premiums. Tax credits reduce your tax liability dollar-for-dollar.
• Strengthen your business . Offering health insurance to employees could lead to a stronger business overall if workers experience greater job satisfaction, miss fewer days of work because they’re able to get adequate healthcare when they need it, and are more productive while on the job.

Eligible small businesses will need to file IRS Form 8941 , Credit for Small Employer Health Insurance Premiums, to qualify for this tax benefit.

Small business owners may choose from multiple types of health insurance plans. Understanding how they compare is important when choosing a plan.

• PPO plans : Preferred provider organization (PPO) plans allow covered individuals to pay less out of pocket for care when they use in-network doctors, hospitals, and providers. Employees would still be able to seek care out of the network, but will pay more for it.
• HMO plans : Health maintenance organization (HMO) plans can have lower out-of-pocket costs for covered employees, but are more restrictive regarding which doctors, hospitals, and providers you can visit. HMO plans are often focused on wellness and preventative care.
• EPO plans : Exclusive provider organization (EPO) plans only cover healthcare costs when an employee uses an in-network provider. These plans can allow exceptions for emergencies.
• HSA-qualified plans : HSA-qualified plans or high-deductible health plans carry higher deductibles, but offer employees access to a Health Savings Account (HSA) . An HSA offers triple tax benefits to employees in the form of deductible contributions, tax-deferred growth, and tax-free withdrawals when the money is used for eligible healthcare expenses.
• POS plans : Point of service (POS) plans have lower out-of-pocket costs when employees use in-network providers. One key thing to note: These plans require a referral to see a specialist.
• Indemnity plans : Indemnity plans allow covered employees to visit any doctor, hospital, or healthcare provider, with costs covered by the plan once they meet a certain deductible. These are sometimes called fee-for-service plans since they require employees to pay premiums, deductibles , and co-insurance .

Affordability is likely to be a key concern when choosing a health insurance plan for your employees. The plan needs to be affordable for them to meet ACA standards, but it also needs to be affordable for your business if you’ll be paying some of the premium costs.

Here are some tips for finding affordable small business health insurance.

Use the Small Business Health Options Program (SHOP)

The Small Business Health Options Program (SHOP) is designed for small employers who want to provide health and/or dental insurance to their employees. You’ll need to be eligible for SHOP to purchase insurance through the program. You’re eligible if:

• Your business has one to 50 full-time equivalent employees.
• You plan to offer coverage to all full-time employees.
• You anticipate enrolling at least 70% of the employees to whom you offer insurance.
• Your business has an office or employee work site in the state whose SHOP you plan to use.

There are certain benefits associated with using SHOP to find health plans. Business owners can:

• Easily compare pricing and coverage for multiple plans in one place
• Opt to offer more than one plan to employees
• Choose how much to pay toward premiums
• Establish an appropriate waiting period for offering coverage to eligible employees

All of the information you need is centralized, but if you need help making sense of any of it, you can work with a SHOP-registered insurance agent or broker.

Use a PEO Service

A PEO, or professional employer organization, helps small businesses get the insurance they need. Effectively, when you join a PEO, you enter into a co-employment agreement. All of your employees then get access to the health plan options extended to other businesses that have joined the PEO.

You don’t give up any control over the running of your business, but joining a PEO makes that company the employer of record for your employees. Joining a PEO could offer your employees a wider range of plans to choose from, and it can take the guesswork out of trying to choose a plan on your own.

Partner with Purchasing Alliances

Purchasing alliances or cooperatives comprise multiple businesses that come together to purchase insurance collectively. Joining an alliance not only may offer more possibilities in terms of the types of coverage and plans you’ll have access to, but also could save money if you’re able to get access to affordable health insurance that isn’t available elsewhere.

One of the most important things to consider about joining a purchasing alliance is the types of businesses it serves. The more similar that member businesses are in terms of structure and number of employees, the more likely that the plans offered will reflect the needs of the member group as a whole.

Finding the right health insurance plan can be challenging, as there are a multitude of factors to consider, the first being where to buy coverage. Small businesses with fewer than 50 employees can look for options through SHOP or get help from a SHOP-registered broker or agent. Larger businesses can shop for plans with the help of an agent or PEO, or contact insurance companies directly.

When comparing small business health insurance plans, it’s important to consider:

• Premium costs
• Coverage options
• Network providers
• Employee needs

Business owners who are looking for plans through SHOP can easily compare coverage and prices for plans available in their area. All you’ll need to do is enter your ZIP code to see what options you might have.

As you look at SHOP plans, here are some other considerations to keep in mind:

• Will you offer one plan or a choice of plans?
• Will coverage be limited to medical only, or will you add dental coverage?
• How much of employee premiums do you plan to pay?
• Will you offer coverage to full-time employees only or include part-time workers?
• When will the coverage begin?
• What waiting period will you impose before employees can become eligible for coverage?

There are four types of plans offered through SHOP: bronze, silver, gold, and platinum. The amount employees pay depends on the plan, with the highest employee contribution at the bronze level and the lowest at the platinum level. Once you choose a plan and are ready to enroll, you can do so through a registered SHOP agent or broker, or the insurance company.

Some states have their own websites for SHOP enrollment, which you’ll need to use to choose a plan.  

Navigating healthcare rules and coverage options can be confusing for new and seasoned business owners alike. If you’re interested in getting more information about what’s required under the ACA or how to find health coverage as a small business owner, you might find these resources helpful:

• Health insurance for your business and employees (HealthCare.gov)
• How to enroll in SHOP insurance (HealthCare.gov)
• Small Business Healthcare Tax Credit and the SHOP Marketplace (IRS.gov)
• Employer Shared Responsibility Provisions (IRS.gov)
• Small Business—Get Answers Page (HealthCare.gov)

Small businesses are eligible for SHOP insurance plans if they have one to 50 employees. If you’re eligible, you don’t need to wait for an open enrollment period to start offering coverage to your employees.

Small business owners can find the best health plan by first understanding what they and their employees may need. Businesses that are SHOP-eligible may look to the federal marketplace first to compare plans. Alternatively, businesses of any size may consult a private insurance agent or broker to help them make sense of the different health plan options that are available.

On average, the annual premium for single coverage for covered employees at small firms was $8,722 in 2023. The average premium cost was slightly lower for covered employees at large firms: $8,321. The average premium was $23,621 for family coverage at small firms and $24,104 for covered employees at large firms.

Health insurance is a requirement for some small business owners, but it may be optional for others. Offering health insurance, whether you’re required to do so or choose to, could help your employees and your business thrive.

When searching for coverage, it’s important to shop around to find the best health plan options for small businesses so that you can make an informed decision for your business.

Internal Revenue Service. “ Affordable Care Act Tax Provisions for Large Employers .”

Internal Revenue Service. “ Determining If an Employer Is an Applicable Large Employer .”

HealthCare.gov (Health Insurance Marketplace). “ Health Coverage If You’re Self-Employed .”

Internal Revenue Service. “ Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act .”

HealthCare.gov (Health Insurance Marketplace). “ Minimum Value .”

HealthCare.gov (Health Insurance Marketplace). “ Affordable Coverage .”

Internal Revenue Service. “ Small Business Health Care Tax Credit Questions and Answers: Calculating the Credit .”

HealthCare.gov (Health Insurance Marketplace). “ Exploring Coverage Options for Small Businesses .”

HealthCare.gov (Health Insurance Marketplace). “ Special Enrollment Period (SEP) .”

Connecticut State Office of the Health Care Advocate. “ How Indemnity Plans Work .”

HealthCare.gov (Health Insurance Marketplace). “ How to Pick a Health Insurance Plan .”

HealthCare.gov (Health Insurance Marketplace). “ How to Enroll in SHOP Insurance .”

HealthCare.gov (Health Insurance Marketplace). “ Find Out If Your Small Business Qualifies for SHOP .”

HealthCare.gov (Health Insurance Marketplace). “ How to Offer SHOP Health Insurance to Your Employees .”

Kaiser Family Foundation. “ 2023 Employee Health Benefits Survey .”

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The health care sector is an amazing place for aspiring entrepreneurs to open up shop. Exploring health care business ideas is smart for lots of reasons.

There’s an opportunity to do a world of good by serving an aging American population and helping those struggling with the national drug crisis. There are lots of new medical and technological advances, and widespread interest in health and wellness, too. And those are all great incentives for passionate entrepreneurs.

Plus, these factors combined mean there's a thriving market for health-related businesses. Aspiring new business owners can turn one of many health care business ideas into a viable way to make a living, including those entrepreneurs who want to work remotely.

This list of health care business ideas should get you started — and maybe inspire you to explore starting a business.

Why businesses in health care are worth exploring

Nationwide spending on health is projected to grow at an average rate of 5.5% annually through 2026. That’s one percentage point faster than the national GDP is projected to grow during that same time. And by 2026, health care is projected to account for nearly 20% of the GDP.

Employment in health care-related occupations is projected to grow 18% from 2016 to 2026, much faster than the average for all occupations, according to the U.S. Bureau of Labor Statistics. Nearly half of the 20 occupations projected to have the highest percentage increase in employment by 2026 are in the health care industry.

What that spells is a lot of opportunity.

One big reason for the surge in health care spending: By 2030, the Census Bureau projects, approximately one-fifth of the population will be 65 and older. This will be the first time in history that the number of Americans over age 65 will surpass the number of Americans under 18.

Keep those numbers in mind as you look through this list of health care business ideas.

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Once we uncover your personalized matches, our team will consult you on the process moving forward.

18 health care business ideas to consider

1. medical transcription services.

Medical transcriptionists transcribe doctors’, nurses’ and other health care practitioners’ voice recordings into written documents for patients’ records. Speech recognition technology has definitely improved the efficiency of medical transcription, sure. But it certainly hasn’t yet replaced the need for human transcriptionists to review and correct the transcriptions to make sure they’re accurate.

This is a great business to run from home because you can make your own hours, and all of the work can be done digitally. Plus, if you’re digitally savvy and can create an efficient (and secure) way to share files, you can really one-up the competition.

2. Medical records management

Start a service that manages medical records for hospitals, clinics and doctors’ offices. You can work with clients to identify the best records management systems, implement them and provide their staff with training on how to use the systems.

Another approach? You can offer full-service medical records management, and clients can outsource the work to you. This can be helpful for boutique practices and sole practitioners who need the organization but can’t afford the in-house staff.

3. Physical/occupational therapy center

Physical therapists help patients recover from injuries to regain their full range of motion and reduce pain. Occupational therapists provide more specific therapy to help patients perform tasks of daily living, such as dressing themselves or feeding themselves. You can specialize in one or the other, or put both under one roof. Note that this does require certification.

4. Develop a health care app

Both health care providers and individuals alike are increasingly turning to mobile apps to track, record and manage medical conditions. The world is your oyster if you’re skilled in app development, so you might want to consider developing your own health care app targeting these markets. Do some field research to find out where your skills can fit a need.

5. Diabetic care center

According to the CDC, 9.4% of all Americans either have diabetes or are prediabetic . Opening a diabetic care center can help diabetic patients improve their quality of life by providing nutrition counseling, dialysis and other medical services. You can also provide preventive help such as teaching healthy eating habits or providing support groups for diabetics.

6. Home health care service

A home health care business provides in-home medical care for recently discharged hospital patients, patients with chronic health conditions, seniors and others who need assistance managing their health.

In states with rapidly aging populations, like Florida and California, not only could this be a benefit to the community — but also a strong business prospect for you.

7. Medical foot care

A growing population of seniors and diabetics means more need for foot care services. Something as simple as trimming toenails can be impossible for seniors and overweight patients who can’t reach their feet. You can either open a foot care clinic or save patients a trip to the podiatrist by providing mobile foot care services in their homes or in a van. You’ll need to train as a podiatrist or hire one.

8. Drug treatment/rehabilitation center

As drug use has escalated to become a national crisis in the United States, legitimate places for people to seek treatment for their addictions and rebuild their lives are needed more than ever. Every day, more than 115 Americans die after overdosing on opioids, according to the National Institute on Drug Abuse .

Open a drug treatment and rehabilitation center to help clients with drug addiction. You can specialize in different types of patients, such as juveniles or more senior patients.

9. Childbirth services

Today's expectant parents want to control every aspect of childbirth, and that often includes having a midwife or doula present at the birth. The use of midwives is increasing , according to the American College of Nurse-Midwives.

Midwives are trained health care providers who assist women during childbirth, while a doula is more like a pregnancy coach who helps couples arrange all aspects of the birth and caring for the newborn. You can either become certified yourself or open a business that employs contractors under your umbrella.

10. Medical billing service

Medical billing requires performing complex coding when submitting insurance claims. Keep in mind, certification is required in this field to ensure that doctors and other health care practitioners get paid.

Although big hospitals and health care organizations often have in-house staff, small medical practices that don’t have time to manage billing and coding themselves are an ideal market for medical billing services. Acquire and learn medical billing software, get trained in proper coding and target these smaller medical practices to take medical billing hassles off their hands. And you can even earn your certification online.

11. Nutritionist/dietitian

If you want to help people improve their nutritional intake and habits, you can build a business as a nutritionist or dietitian. Only nutritionists who get a license with the Commission on Dietetic Registration, or CDR, can advertise themselves as dietitians. Some states regulate nutritionists and others don’t.

You can specialize in different types of clients, such as sports nutrition, nutrition for weight loss or holistic nutrition.

12. Alternative health care

Acupuncture and massage therapy are two alternative health care business ideas that are becoming more popular. Many are using these services to supplement their traditional medical treatment — or as a primary treatment unto itself.

Check with your state to see what the requirements are to practice; they vary across the country. Even when health insurance plans don’t provide coverage, Americans are more willing to pay out-of-pocket for these types of care than they used to be.

13. Health information website

If you have health care expertise — or access to people who do — consider starting a website to provide health care information and advice. You can create all kinds of content, such as podcasts, YouTube videos and even online classes, in addition to blog posts.

You might even be able to get health care experts to contribute content for free in exchange for the publicity your site offers. There are a lot of options; just make certain that you do some market research to figure out the white space to fill, and find viable revenue streams to make your business highly sustainable, too.

14. Medical supply sales

Seniors, people with disabilities and those with chronic illnesses have an ongoing need for medical supplies and equipment. This can include walkers, braces, bedpans and more.

Although you can open a physical store, keep in mind that your target customers will often have difficulty getting to your location, so an online store is likely a better bet. Again, research here will be key so you can make sure that you’re stocking the right products and marketing in the right places.

15. Stylish uniforms for medical professionals

Medical professionals who wear scrubs to work are always looking for affordable and durable uniforms. They’re also looking for stylish options — and those aren’t as easy to find. Start a store selling scrubs, comfortable shoes, lab coats and other gear for health care professionals. You can design the goods yourself or source them from multiple places, and encourage your customers with word-of-mouth incentives to drive sales.

16. Hearing aid dispensary

Because hearing aids generally aren’t covered by health insurance, this can be a lucrative health care business idea if you find the right customer base. You might want to open a location to provide hearing tests, recommendations and hearing aid fittings and care. You could even outfit a mobile van to come to customers' homes to clean and repair their hearing aids as an extra service.

17. Respite care service for caregivers

Whether they’re parents caring for severely disabled children or adult children caring for aging parents, caregivers have a stressful job. Provide a much-needed break for caregivers by starting a respite care business. Your caregivers can come in for a few hours or a few days, giving family caregivers a chance to rest.

18. Medical marijuana dispensary

As a growing number of states legalize medical marijuana, this $8 billion industry is projected to continue its growth, according to IBISWorld . Opening a medical marijuana dispensary can be a profitable business in the right location; however, changing state and federal regulations could affect your startup. (Marijuana is still illegal under federal law.)

Frequently asked questions

How do i start a health care business.

When you start a health care business, it can be helpful to begin by writing a business plan, registering your business and hiring employees. While all businesses need to obtain any necessary licenses, permits and forms of insurance, health care businesses may require earning professional designations or taking out extra forms of insurance. Research what you need to run your business safely and legally before you launch.

How do I start a home health care business?

Starting a home health care business requires a high level of professionalism, even if you’re running a business where the bulk of the work will occur in your clients’ homes. For example, you may still need office space to train your employees. Like starting any business, it is important to write a business plan, register your business and create proper business procedures. You should also obtain any necessary licenses, permits and insurance for running a business in your area, as well as for working within the health care industry.

How do I write a business plan in health care?

In general, a business plan is an organizational tool that business owners can follow when they need guidance. This document can also tell outside parties, such as investors, about your business and its value. A good business plan should include thorough research about your industry, market and competitors, as well as dive into your financials, products and services and your marketing plan. When writing a business plan in health care, it will be important to do heavy research on the industry, as well as outline clearly what medical services or products you will be offering and why you or your staff are qualified to run a health care business safely.

Start Your Dream Business

The bottom line

There are a lot of potential great health care business ideas for entrepreneurs interested in the health care sector — and many opportunities for health care business ideas to become real, sustainable businesses.

Be sure to check regulations, licensing, professional training or degrees needed for these businesses before you get started, and do lots of market research. Don’t forget that “care” part, of course.

On a similar note...

Healthcare Business Plan Template

Written by Dave Lavinsky

Healthcare Business Plan

You’ve come to the right place to create your Healthcare business plan.

We have helped over 10,000 entrepreneurs and business owners create business plans and many have used them to start or grow their Healthcare companies.

Below is a template to help you create each section of your Healthcare business plan.

Executive Summary

Business overview.

Riverside Medical is a family medical clinic located in San Francisco, California. Our goal is to provide easy access to quality healthcare, especially for members of the community who have low to moderate incomes. Our clinic provides a wide range of general and preventative healthcare services, including check-ups, minor surgeries, and gynecology. Anyone of any age or group is welcome to visit our clinic to get the healthcare that they need.

Our medical practitioners and supporting staff are well-trained and have a passion for helping improve the health and well-being of our clients. We serve our patients not just with our knowledge and skills but also with our hearts. Our clinic was founded by Samantha Parker, who has been a licensed doctor for nearly 20 years. Her experience and compassion will guide us throughout our mission.

Product Offering

Riverside Medical will provide extensive general care for all ages, creating a complete healthcare solution. Some of the services included in our care include the following:

• Primary care: annual checkups, preventative screenings, health counseling, diagnosis and treatment of common conditions
• Gynecology: PAP tests, annual well-woman exam, and family planning
• Pediatrics: infant care, annual physicals, and immunizations
• Minor procedures: stitches, casts/splints, skin biopsies, cyst removals, and growth lacerations
• Health and wellness: weight loss strategies, nutrition guidance, hormone balance, and preventive and routine services

The costs will depend upon the materials used, the physician’s time, and the amount designated for each procedure. Medical bills will be billed either directly to the patient or to their insurance provider.

Customer Focus

Riverside Medical will primarily serve the community living and working within the San Francisco bay area. The city is diverse and growing and includes people of all ages, ethnicities, and backgrounds. Everyone is welcome to visit our clinic to receive the health care they need.

Management Team

Riverside Medical’s most valuable asset is the expertise and experience of its founder, Samantha Parker. Samantha has been a licensed family doctor for 20 years now. She spent the most recent portion of her career on medical mission trips, where she learned that many people are not privileged to have access to quality medical services. Samantha will be responsible for ensuring the general health of her patients and creating a viable and profitable business medical practice.

Riverside Medical will also employ nurses, expert medical staff, and administrative assistants that also have a passion for healthcare.

Success Factors

Riverside Medical will be able to achieve success by offering the following competitive advantages:

• Location: Riverside Medical’s location is near the center of town. It’s visible from the street with many people walking to and from work on a daily basis, giving them a direct look at our clinic, most of which are part of our target market.
• Patient-oriented service: Riverside Medical will have a staff that prioritizes the needs of the patients and educates them on the proper way how to take care of themselves.
• Management: Samantha Parker has a genuine passion for helping the community, and because of her previous experience, she is fully equipped and overqualified to open this practice. Her unique qualifications will serve customers in a much more sophisticated manner than our competitors.
• Relationships: Having lived in the community for 25 years, Samantha Parker knows many of the local leaders, newspapers, and other influences. Furthermore, she will be able to draw from her ties to previous patients from her work at other clinics to establish a starting clientele.

Financial Highlights

Riverside Medical is seeking a total funding of $800,000 of debt capital to open its clinic. The capital will be used for funding capital expenditures and location build-out, acquiring basic medical supplies and equipment, hiring initial employees, marketing expenses, and working capital.

Specifically, these funds will be used as follows:

• Clinic design/build: $100,000
• Medical supplies and equipment: $150,000
• Six months of overhead expenses (rent, salaries, utilities): $450,000
• Marketing: $50,000
• Working capital: $50,000

The following graph below outlines the pro forma financial projections for Riverside Medical.

Company Overview

Who is riverside medical, riverside medical history.

Samantha Parker started the clinic with the goal of providing easy access to good quality health service, especially to those members of the community with low to moderate income. After years of planning, she finally started to build Riverside Medical in 2022. She gathered a group of professionals to fund the project and was able to incorporate and register Riverside Medical with their funding support.

Since its incorporation, Riverside Medical has achieved the following milestones:

• Found clinic space and signed Letter of Intent to lease it
• Developed the company’s name, logo, and website
• Hired a contractor for the office build-out
• Determined equipment and fixture requirements
• Began recruiting key employees with previous healthcare experience
• Drafted marketing campaigns to promote the clinic

Riverside Medical Services

Industry analysis.

The global healthcare market is one of the largest and highest-valued industries in the world. According to Global Newswire, the global healthcare services market is currently valued at $7548.52 billion and is expected to reach $10414.36 billion in 2026. This growth is expected to continue for the foreseeable future.

The biggest drivers of industry growth throughout the next decade will be a continual increase in illnesses and diseases as well as a quickly aging population. With more people aging and needing daily/frequent care, hospitals and medical clinics are bound to be in even more demand than they already are.

One obstacle for the industry is the rising cost of care. Though this results in greater profits, more and more Americans cannot afford basic medical care. Therefore, they are opting out of procedures they believe are unnecessary or unimportant.

Despite the challenges of the next decade, the industry is still expected to see substantial growth and expansion.

Customer Analysis

Demographic profile of target market.

Riverside Medical will serve the residents of the San Francisco bay area as well as those who work in the area.

The population of the area experiences a large income gap between the highest earners and the lowest earners. Therefore, it is hard for middle and lower-class families to find quality care that is affordable. As a result, they are in need of the services that we offer and are looking for accessible medical care.

The precise demographics of San Francisco are as follows:

Customer Segmentation

Our clinic is a general family practice and will treat patients of all ages, incomes, physical abilities, races, and ethnicities. As such, there is no need to create marketing materials targeted at only one or two of these groups, but we can appeal to all with a similar message.

Competitive Analysis

Direct and indirect competitors.

Riverside Medical will face competition from other companies with similar business profiles. A description of each competitor company is below.

City Medical

Founded in 2008, City Medical is a membership-based, primary-care practice in the heart of the city. City Medical offers a wide range of primary care services for patients who subscribe to the practice for an annual fee. Patients enjoy personalized care, including office visits, as well as the diagnosis and treatment of common health problems. The patient membership fee covers the services listed below, and most care is received in-office. However, some additional services, such as lab testing and vaccinations, are billed separately. Furthermore, though the annual fee is convenient for some, it is too high for many families, so many are priced out of care at this facility.

Bay Doctors

Bay Doctors is a primary care practice that provides highly personalized medical care in the office or patients’ homes. Bay Doctors includes a team of dedicated healthcare professionals with dual residency in Emergency Medicine and Internal Medicine. The practice offers same-day/next-day appointments, telemedicine, office visits, and home visits. Some of the medical care services they provide are primary care, urgent care, emergency care, gynecology, pediatrics, and minor procedures.

Community Care

Established in 1949, Community Care is a non-profit regional healthcare provider serving the city and surrounding suburbs. This facility offers a wide variety of medical services, including 24-hour emergency care, telemedicine, primary care, and more. In addition to their medical care, they have a wide variety of fundraising activities to raise money to operate the hospital and help families cover the costs of their care.

Competitive Advantage

Riverside Medical enjoys several advantages over its competitors. These advantages include:

Marketing Plan

Brand & value proposition.

The Riverside Medical brand will focus on the company’s unique value proposition:

• Client-focused healthcare services, where the company’s interests are aligned with the customer
• Service built on long-term relationships
• Big-hospital expertise in a small-clinic environment

Promotions Strategy

The promotions strategy for Riverside Medical is as follows:

Riverside Medical understands that the best promotion comes from satisfied customers. The company will encourage its patients to refer their friends and family by providing healthcare benefits for every new client produced. This strategy will increase in effectiveness after the business has already been established.

Direct Mail

The company will use a direct mail campaign to promote its brand and draw clients, as well. The campaign will blanket specific neighborhoods with simple, effective mail advertisements that highlight the credentials and credibility of Riverside Medical.

Website/SEO

Riverside Medical will invest heavily in developing a professional website that displays all of the clinic’s services and procedures. The website will also provide information about each doctor and medical staff member. The clinic will also invest heavily in SEO so the brand’s website will appear at the top of search engine results.

Social Media

Riverside Medical will invest heavily in a social media advertising campaign. The marketing manager will create the company’s social media accounts and invest in ads on all social media platforms. It will use targeted marketing to appeal to the target demographics.

Riverside Medical’s pricing will be lower than big hospitals. Over time, client testimonials will help to maintain our client base and attract new patients. Furthermore, we will be able to provide discounts and incentives for lower-income families by connecting with foundations and charities from people who are interested in helping.

Operations Plan

The following will be the operations plan for Riverside Medical.

Operation Functions:

• Samantha Parker is the founder of Riverside Medical and will operate as the sole doctor until she increases her patient list and hires more medical staff. As the clinic grows, she will operate as the CEO and take charge of all the operations and executive aspects of the business.
• Samantha is assisted by Elizabeth O’Reilly. Elizabeth has experience working as a receptionist at a fast-paced hospital and will act as the receptionist/administrative assistant for the clinic. She will be in charge of the administrative and marketing aspects of the business.
• Samantha is in the process of hiring doctors, nurses, and other medical staff to help with her growing patient list.

Milestones:

The following are a series of path steps that will lead to the vision of long-term success. Riverside Medical expects to achieve the following milestones in the following twelve months:

3/202X Finalize lease agreement

5/202X Design and build out Riverside Medical location

7/202X Hire and train initial staff

9/202X Kickoff of promotional campaign

11/202X Reach break-even

1/202X Reach 1000 patients

Financial Plan

Key revenue & costs.

Riverside Medical’s revenues will come primarily from medical services rendered. The clinic will either bill the patients directly or their insurance providers.

The major cost drivers for the clinic will include labor expenses, lease costs, equipment purchasing and upkeep, and ongoing marketing costs.

Funding Requirements and Use of Funds

Key assumptions.

Below are the key assumptions required to achieve the revenue and cost numbers in the financials and to pay off the startup business loan.

• Year 1: 120
• Year 2: 150
• Year 3: 200
• Year 4: 275
• Year 5: 400
• Annual lease: $50,000

Financial Projections

Income statement, balance sheet, cash flow statement, healthcare business plan faqs, what is a healthcare business plan.

A healthcare business plan is a plan to start and/or grow your healthcare business. Among other things, it outlines your business concept, identifies your target customers, presents your marketing plan and details your financial projections.

You can easily complete your Healthcare business plan using our Healthcare Business Plan Template here .

What are the Main Types of Healthcare Businesses?

There are a number of different kinds of healthcare businesses , some examples include: Nursing care, Physical home health care, or Home health care aides:

How Do You Get Funding for Your Healthcare Business Plan?

Healthcare businesses are often funded through small business loans. Personal savings, credit card financing and angel investors are also popular forms of funding.

What are the Steps To Start a Healthcare Business?

Starting a healthcare business can be an exciting endeavor. Having a clear roadmap of the steps to start a business will help you stay focused on your goals and get started faster.

1. Develop A Healthcare Business Plan - The first step in starting a business is to create a detailed healthcare business plan that outlines all aspects of the venture. This should include potential market size and target customers, the services or products you will offer, pricing strategies and a detailed financial forecast. 

2. Choose Your Legal Structure - It's important to select an appropriate legal entity for your healthcare business. This could be a limited liability company (LLC), corporation, partnership, or sole proprietorship. Each type has its own benefits and drawbacks so it’s important to do research and choose wisely so that your healthcare business is in compliance with local laws.

3. Register Your Healthcare Business - Once you have chosen a legal structure, the next step is to register your healthcare business with the government or state where you’re operating from. This includes obtaining licenses and permits as required by federal, state, and local laws.

4. Identify Financing Options - It’s likely that you’ll need some capital to start your healthcare business, so take some time to identify what financing options are available such as bank loans, investor funding, grants, or crowdfunding platforms.

5. Choose a Location - Whether you plan on operating out of a physical location or not, you should always have an idea of where you’ll be based should it become necessary in the future as well as what kind of space would be suitable for your operations.

6. Hire Employees - There are several ways to find qualified employees including job boards like LinkedIn or Indeed as well as hiring agencies if needed – depending on what type of employees you need it might also be more effective to reach out directly through networking events.

7. Acquire Necessary Healthcare Equipment & Supplies - In order to start your healthcare business, you'll need to purchase all of the necessary equipment and supplies to run a successful operation. 

8. Market & Promote Your Business - Once you have all the necessary pieces in place, it’s time to start promoting and marketing your healthcare business. This includes creating a website, utilizing social media platforms like Facebook or Twitter, and having an effective Search Engine Optimization (SEO) strategy. You should also consider traditional marketing techniques such as radio or print advertising.

Other Helpful Business Plan Templates

Nonprofit Business Plan Template Non-Emergency Medical Transportation Business Plan Template Medical Practice Business Plan Template Home Health Care Business Plan Template

Healthcare Business Plan Template

Written by Dave Lavinsky

There are several types of Healthcare businesses, from family medicine practices to urgent care centers to home health care agencies. Regardless of the type of healthcare business you have, a business plan will keep you on track and help you grow your healthcare business in an organized way. In addition, if you plan to seek funding, investors and lenders will use your business plan to determine the level of risk.

Download our Ultimate Business Plan Template here >

Below is the business plan outline you should use to create a business plan for your healthcare company. Also, here are links to several healthcare business plan templates:

• Assisted Living Business Plan
• Counseling Private Practice Business Plan Template
• Dental Business Plan
• Home Health Care Business Plan
• Medical Practice Business Plan Template
• Medical Spa Business Plan Template
• Non Medical Home Care Business Plan Template
• Nursing Home Business Plan Template
• Pharmacy Business Plan
• Urgent Care Business Plan

Finish Your Business Plan Today!

Healthcare business plan example outline, executive summary.

Although it serves as the introduction to your business plan, your executive summary should be written last. The first page helps financiers decide whether to read the full plan, so provide the most important information. Give a clear and concise description of your healthcare company. Provide a summary of your market analysis that proves the need for another healthcare business, and explain your company’s unique qualifications to meet that need.  

Company Analysis

Your company analysis explains your healthcare business as it exists right now. Describe the company’s founding, current stage of business, and legal structure. Highlight any past milestones, such as lining up clients or hiring healthcare providers with a proven track record. Elaborate on your unique qualifications, such as expertise in a currently underserved niche market.

Industry Analysis

The healthcare industry is incredibly large and diverse, but your analysis should focus on your specific segment of the market. Do you specialize in pediatric healthcare? senior healthcare? emergency medicine? family medicine? Figure out where your healthcare company fits in, and then research the current trends and market projections that affect your niche. Create a detailed strategy for overcoming any obstacles that you uncover.  

Customer Analysis

Who will your healthcare company serve? Are they families? The elderly? What is important to them in a healthcare business? How do they select a healthcare provider? Narrow down their demographics as closely as you can, and then figure out what their unique needs are and how you can fulfill them.

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Competitive Analysis

Your direct competitors are those healthcare companies that fulfill the same needs for the same target market as yours. Your indirect competitors are healthcare businesses that target a different market, or other companies that fulfill a different need for your target market. Describe each of your direct competitors individually, and talk about the things that set your healthcare company apart. Categorize your indirect competitors as a group and talk about them as a whole.  

Marketing Plan

A solid marketing plan is based on the four P’s: Product, Price, Promotion, and Place. The Product section describes the healthcare you sell along with any other services you provide. Price will change according to the specifics of the property, but you can delineate your fees here. Promotion is your means of getting new business. Place is your physical office location, along with your web presence and the areas where you sell. Another category, Customer retention, refers to the ways you will build loyalty.

Operations Plan

Your operations plan explains your methods for meeting the goals you set forth. Everyday short-term processes include all of the daily tasks involved in servicing clients. Long-term processes are the ways you will meet your defined business goals, such as expanding into new markets or new types of service.  

Management Team

The management team section highlights the backgrounds of the key members of your team. Focus on those aspects that prove your team’s ability to build and run a successful company. A business mentor or advisor can help fill in any gaps, provided you can identify the specific ways that your advisor will influence your company’s growth.  

Financial Plan

Investors and lenders heavily scrutinize the financial plan, but it is often the most challenging part of the business plan to write. Healthcare is a strong market, it usually not subject to economic turns. The financial plan requires you to detail your individual revenue streams by implementation timeline and relative importance, and disclose any sources of outside funding. You also need to summarize your past and future Income Statements, Cash Flow Statements, and Balance Sheets, based on key assumptions that must be both reasonable and verifiable based on an analysis of similar companies. You should also provide a solid exit strategy that shows your understanding of the market and your desire to capitalize on profitability.  

Your full financial projections should be attached in the appendix along with any other documents that support your claims, such as letters from key partners.

Healthcare Business Plan FAQs

What is the easiest way to complete my healthcare business plan.

Growthink's Ultimate Business Plan Template allows you to quickly and easily complete your Healthcare Business Plan.

What is the Goal of a Business Plan's Executive Summary?

The goal of your Executive Summary is to quickly engage the reader. Explain to them the type of healthcare business you are operating and the status; for example, are you a startup, do you have a healthcare business that you would like to grow, or are you operating a chain of healthcare businesses?

Don’t you wish there was a faster, easier way to finish your Healthcare business plan?

OR, Let Us Develop Your Plan For You

Since 1999, Growthink has developed business plans for thousands of companies who have gone on to achieve tremendous success.   Click here to see how our professional business plan writers can create your business plan for you.

Other Helpful Business Plan Articles & Templates

The future of healthcare: Value creation through next-generation business models

The healthcare industry in the United States has experienced steady growth over the past decade while simultaneously promoting quality, efficiency, and access to care. Between 2012 and 2019, profit pools (earnings before interest, taxes, depreciation, and amortization, or EBITDA) grew at a compound average growth rate of roughly 5 percent. This growth was aided in part by incremental healthcare spending that resulted from the 2010 Affordable Care Act. In 2020, subsidies for qualified individual purchasers on the marketplaces and expansion of Medicaid coverage resulted in roughly $130 billion 1 Federal Subsidies for Health Insurance Coverage for People Under Age 65: CBO and JCT’s March 2020 Projections, Congressional Budget Office, Washington, DC, September 29, 2020, cbo.gov. 2 Includes adults made eligible for Medicaid by the ACA and marketplace-related coverage and the Basic Health Program. of incremental healthcare spending by the federal government.

The next three years are expected to be less positive for the economics of the healthcare industry, as profit pools are more likely to be flat. COVID-19 has led to the potential for economic headwinds and a rebalancing of system funds. Current unemployment rates (6.9 percent as of October 2020) 3 The employment situation—October 2020 , US Department of Labor, November 6, 2020, bls.gov. indicate some individuals may move from employer-sponsored insurance to other options. It is expected that roughly between $70 billion and $100 billion in funding may leave the healthcare system by 2022, compared with the expected trajectory pre-COVID-19. The outflow is driven by coverage shifts out of employer-sponsored insurance, product buy-downs, and Medicaid rate pressures from states, partially offset by increased federal spending in the form of subsidies and cost sharing in the Individual market and in Medicaid funding.

Underlying this broader outlook are chances to innovate (Exhibit 1). 4 Smit S, Hirt M, Buehler K, Lund S, Greenberg E, and Govindarajan A, “ Safeguarding our lives and our livelihoods: The imperative of our time ,” March 23, 2020, McKinsey.com. Innovation may drive outpaced growth in three categories: segments that are anticipated to rebound from poor performance over recent years, segments that benefit from shifting care patterns that result directly from COVID-19, and segments where growth was expected pre-COVID-19 and remain largely unaffected by the pandemic. For the payer vertical, we estimate profit pools in Medicaid will likely increase by more than 10 percent per annum from 2019 to 2022 as a result of increased enrollment and normalized margins following historical lows. In the provider vertical, the rapid acceleration in the use of telehealth and other virtual care options spurred by COVID-19 could continue. 5 Bestsennyy O, Gilbert G, Harris A, and Rost J, “ Telehealth: A quarter-trillion-dollar post-COVID-19 reality? ” May 29, 2020, McKinsey.com. Growth is expected across a range of sub-segments in the services and technology vertical, as specialized players are able to provide services at scale (for example, software and platforms and data and analytics). Specialty pharmacy is another area where strong growth in profit pools is likely, with between 5 and 10 percent compound annual growth rate (CAGR) expected in infusion services and hospital-owned specialty pharmacy sub-segments.

Strategies that align to attractive and growing profit pools, while important, may be insufficient to achieve the growth that incumbents have come to expect. For example, in 2019, 34 percent of all revenue in the healthcare system was linked to a profit pool that grew at greater than 5 percent per year (from 2017 to 2019). In contrast, we estimate that only 13 percent of revenue in 2022 will be linked to profit pools growing at that rate between 2019 and 2022. This estimate reflects that profit pools are growing more slowly due to factors that include lower membership growth, margin pressure, and lower revenue growth. This relative scarcity in opportunity could lead to increased competition in attractive sub-segments with the potential for profits to be spread thinly across organizations. Developing new and innovative business models will become important to achieve the level of EBITDA growth observed in recent years and deliver better care for individuals. The good news is that there is significant opportunity, and need, for innovation in healthcare.

New and innovative business models across verticals can generate greater value and deliver better care for individuals

Glimpse into profit pool analyses and select sub-segments.

Within the context of these overarching observations, the projections for specific sub-segments are nuanced and tightly connected to the specific dynamics each sub-segment is currently facing:

• Payer—Small Group: Small group has historically seen membership declines and we expect this trend to continue and/or accelerate in the event of an economic downturn. Membership declines will increase competition and put pressure on incumbent market leaders to both maintain share and margin as membership declines, but fixed costs remain.
• Payer—Medicare Advantage: Historic profit pool growth in the Medicare Advantage space has been driven by enrollment gains that result from demographic trends and a long-term trend of seniors moving from traditional Medicare fee-for-service programs to Medicare Advantage plans that have increasingly offered attractive ancillary benefits (for example, dental benefits, gym memberships). Going forward, we expect Medicare members to be relatively insulated from the effects of an economic downturn that will impact employers and individuals in other payer segments.
• Provider—General acute care hospitals: Cancelation of elective procedures due to COVID-19 is expected to lead to volume and revenue reductions in 2019 and 2020. Though volume is expected to recover partially by 2022, growth will likely be slowed due to the accelerated shift from hospitals to virtual care and other non-acute settings. Payer mix shifts from employer-sponsored to Medicaid and uninsured populations in 2020 and 2021 are also likely to exert downward pressure on hospital revenue and EBITDA, possibly driving cost-optimization measures through 2022.
• Provider—Independent labs: COVID-19 testing is expected to drive higher than average utilization growth in independent labs through 2020 and 2021, with more typical utilization returning by 2022. However, labs may experience pressure on revenue and EBITDA growth as the payer mix shifts to lower-margin segments, offsetting some of the gains attributed to utilization.
• Provider—Virtual office visits: Telehealth has helped expand access to care at a time when the pandemic has restricted patients’ ability to see providers in person. Consumer adoption and stickiness, along with providers’ push to scale-up telehealth offerings, are expected to lead to more than 100 percent growth per annum in the segment from 2019 to 2022, going beyond traditional “tele-urgent” to more comprehensive virtual care.
• HST—Medical financing: The medical financing segment may be negatively impacted in 2020 due to COVID-19, as many elective services for which financing is used have been deferred. However, a quick bounce-back is expected as more patients lacking healthcare coverage may need financing in 2021, and as providers may use medical financing as a lever to improve cash reserves.
• HST—Wearables: Looking ahead, the wearables segment is expected to see a slight dip in 2020 due to COVID-19, but is expected to rebound in 2021 and 2022 given consumer interest in personal wellness and for tracking health indicators.
• Pharma services—Pharmacy benefit management: The growth is expected to return to baseline expectations by 2022 after an initial decline in 2020 and 2021 due to the COVID-19-driven decrease in prescription volume.

New and innovative business models are beginning to show promise in delivering better care and generating higher returns. The existence of these models and their initial successes are reflective of what we have observed in the market in recent years: leading organizations in the healthcare industry are not content to simply play in attractive segments and markets, but instead are proactively and fundamentally reshaping how the industry operates and how care is delivered. While the recipe across verticals varies, common among these new business models are greater alignment of incentives typically involving risk bearing, better integration of care, and use of data and advanced analytics.

Payers—Next-generation managed care models

For payers, the new and innovative business models that are generating superior returns are those that incorporate care delivery and advanced analytics to better serve individuals with increasingly complex healthcare needs (Exhibit 2). As chronic disease and other long-term conditions require more continuous management supported by providers (for example, behavioral health conditions), these next-generation managed care models have garnered notice. Nine of the top ten payers have made acquisitions in the care delivery space. Such models intend to reorient the traditional payer model away from an operational focus on financing healthcare and pricing risk, and toward more integrated managed care models that better align incentives and provide higher-quality, better experience, lower-cost, and more accessible care. Payers that deployed next-generation managed care models generate 0.5 percentage points of EBITDA margin above average expectations after normalizing for payer scale, geographical footprint, and segment mix, according to our research.

The evidence for the effectiveness of these next-generation care models goes beyond the financial analysis of returns. We observe that these models are being deployed in those geographies that have the greatest opportunity to positively impact individuals. Those markets with 1) a critical mass of disease burden, 2) presence of compressible costs (the opportunity for care to be redirected to lower-cost settings), and 3) a market structure conducive to shifting to higher-value sites of care, offer substantial ways to improve outcomes and reduce costs. (Exhibit 3).

Currently, a handful of payers—often large national players with access to capital and geographic breadth that enables acquisition of at-scale providers and technologies—have begun to pursue such models. Smaller payers may find it more difficult to make outright acquisitions, given capital constraints and geographic limitations. M&A activity across the care delivery landscape is leaving smaller and more localized assets available for integration and partnership. Payers may need to increasingly turn toward strategic partnerships and alliances to create value and integrate a range of offerings that address all drivers of health.

Providers—reimagining care delivery beyond the hospital

For health systems, through an investment lens, the ownership and integration of alternative sites of care beyond the hospital has demonstrated superior financial returns. Between 2013 and 2018, the number of transactions executed by health systems for outpatient assets increased by 31 percent, for physician practices by 23 percent, and for post-acute care assets by 13 percent. At the same time, the number of hospital-focused deals declined by 6 percent. In addition, private equity investors and payers are becoming more active dealmakers in these non-acute settings. 6 CapitalIQ, Dealogic, and Irving Levin Associates. 7 In 2018, around 40 percent of all post-acute and outpatient deals were completed by an acquirer other than a traditional provider.

As investment is focused on alternative sites of care, we observe that health systems pursuing diversified business models that encompass a greater range of care delivery assets (for example, physician practices, ambulatory surgery centers, and urgent care centers) are generating returns above expectations (Exhibit 4). By offering diverse settings to receive care, many of these systems have been able to lower costs, enhance coordination, and improve patient experience while maintaining or enhancing the quality of the services provided. Consistent with prior research, 8 Singhal S, Latko B, and Pardo Martin C, “ The future of healthcare: Finding the opportunities that lie beneath the uncertainty ,” January 31, 2018, McKinsey.com. systems with high market share tend to outperform peers with lower market share, potentially because systems with greater share have greater ability not only to ensure referral integrity but also to leverage economies of scale that drive efficiency.

The extent of this outperformance, however, varies by market type. For players with top quartile share, the difference in outperformance between acute-focused players and diverse players is less meaningful. Contrastingly, for bottom quartile players, the increase in value provided by presence beyond the acute setting is more significant. While there may be disadvantages for smaller and sub-scale providers, opportunities exist for these players—as well as new entrants and attackers—to succeed by integrating offerings across the care continuum.

These new models and entrants and their non-acute, technology-enabled, and multichannel offerings can offer a different vision of care delivery. Consumer adoption of telehealth has skyrocketed, from 11 percent of US consumers using telehealth in 2019 to 46 percent now using telehealth to replace canceled healthcare visits. Pre-COVID-19, the total annual revenues of US telehealth players were an estimated $3 billion; with the acceleration of consumer and provider adoption and the extension of telehealth beyond virtual urgent care, up to $250 billion of current US healthcare spend could be virtualized. 9 Bestsennyy O, Gilbert G, Harris A, and Rost J, “ Telehealth: A quarter-trillion-dollar post-COVID-19 reality? ” May 29, 2020, McKinsey.com. These early indications suggest that the market may be shifting toward a model of innovative tech-enabled care, one that unlocks value by integrating digital and non-acute settings into a comprehensive, coordinated, and lower-cost offering. While functional care coordination is currently still at the early stages, the potential of technology and other alternative settings raises the question of the role of existing acute-focused providers in a more integrated and digital world.

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Healthcare services and technology—innovation and integration across the value chain.

Growth in the healthcare services and technology vertical has been material, as players are bringing technology-enabled services to help improve patient care and boost efficiency. Healthcare services and technology companies are serving nearly all segments of the healthcare ecosystem. These efforts include working with payers and providers to better enable the link between actions and outcomes, to engage with consumers, and to provide real-time and convenient access to health information. Since 2014, a large number and value of deals have been completed: more than 580 deals, or $83 billion in aggregate value. 10 Includes deals over $10 million in value. 11 Analysis from PitchBook Data, Inc. and McKinsey Healthcare Services and Technology domain profit pools model. Venture capital and private equity have fueled much of the innovation in the space: more than 80 percent 12 Includes deals over $10 million in value. of deal volume has come from these institutional investors, while more traditional strategic players have focused on scaling such innovations and integrating them into their core.

Driven by this investment, multiple new models, players, and approaches are emerging across various sub-segments of the technology and services space, driving both innovation (measured by the number of venture capital deals as a percent of total deals) and integration (measured by strategic dollars invested as a percent of total dollars) with traditional payers and providers (Exhibit 5). In some sub-segments, such as data and analytics, utilization management, provider enablement, network management, and clinical information systems, there has been a high rate of both innovation and integration. For instance, in the data and analytics sub-segment, areas such as behavioral health and social determinants of health have driven innovation, while payer and provider investment in at-scale data and analytics platforms has driven deeper integration with existing core platforms. Other sub-segments, such as patient engagement and population health management, have exhibited high innovation but lower integration.

Traditional players have an opportunity to integrate innovative new technologies and offerings to transform and modernize their existing business models. Simultaneously, new (and often non-traditional) players are well positioned to continue to drive innovation across multiple sub-segments and through combinations of capabilities (roll-ups).

Pharmacy value chain—emerging shifts in delivery and management of care

The profit pools within the pharmacy services vertical are shifting from traditional dispensing to specialty pharmacy. Profits earned by retail dispensers (excluding specialty pharmacy) are expected to decline by 0.5 percent per year through 2022, in the face of intensifying competition and the maturing generic market. New modalities of care, new care settings, and new distribution systems are emerging, though many innovations remain in early stages of development.

Specialty pharmacy continues to be an area of outpaced growth. By 2023, specialty pharmacy is expected to account for 44 percent of pharmacy industry prescription revenues, up from 24 percent in 2013. 13 Fein AJ, The 2019 economic report on U.S. pharmacies and pharmacy benefit managers , Drug Channels Institute, 2019, drugchannelsinstitute.com. In response, both incumbents and non-traditional players are seeking opportunities to both capture a rapidly growing portion of the pharmacy value chain and deliver better experience to patients. Health systems, for instance, are increasingly entering the specialty space. Between 2015 and 2018 the share of provider-owned pharmacy locations with specialty pharmacy accreditation more than doubled, from 11 percent in 2015 to 27 percent in 2018, creating an opportunity to directly provide more integrated, holistic care to patients.

Challenges emerge for the US healthcare system as COVID-19 cases rise

A new wave of modalities of care and pharmaceutical innovation are being driven by cell and gene therapies. Global sales are forecasted to grow at more than 40 percent per annum from 2019 to 2024. 14 Evaluate Pharma, February 2020. These new therapies can be potentially curative and often serve patients with high unmet needs, but also pose challenges: 15 Capra E, Smith J, and Yang G, “ Gene therapy coming of age: Opportunities and challenges to getting ahead ,” October 2, 2019, McKinsey.com. upfront costs are high (often in the range of $500,000 to $2,000,000 per treatment), benefits are realized over time, and treatment is complex, with unique infrastructure and supply chain requirements. In response, both traditional healthcare players (payers, manufacturers) and policy makers (for example, the Centers for Medicare & Medicaid Services) 16 Centers for Medicare & Medicaid Services, “Medicaid program; establishing minimum standards in Medicaid state drug utilization review (DUR) and supporting value-based purchasing (VBP) for drugs covered in Medicaid, revising Medicaid drug rebate and third party liability (TPL) requirements,” Federal Register , June 19, 2020, Volume 85, Number 119, p. 37286, govinfo.gov. are considering innovative models that include value-based arrangements (outcomes-based pricing, annuity pricing, subscription pricing) to support flexibility around these new modalities.

Innovations also are accelerating in pharmaceutical distribution and delivery. Non-traditional players have entered the direct-to-consumer pharmacy space to improve efficiency and reimagine customer experience, including non-healthcare players such as Amazon (through its acquisition of PillPack in 2018) and, increasingly, traditional healthcare players as well, such as UnitedHealth Group (through its acquisition of DivvyDose in September 2020). COVID-19 has further accelerated innovation in patient experience and new models of drug delivery, with growth in tele-prescribing, 17 McKinsey COVID-19 Consumer Survey conducted June 8, 2020 and July 14, 2020. a continued shift toward delivery of pharmaceutical care at home, and the emergence of digital tools to help manage pharmaceutical care. Select providers have also begun to expand in-home offerings (for example, to include oncology treatments), shifting the care delivery paradigm toward home-first models.

A range of new models to better integrate pharmaceutical and medical care and management are emerging. Payers, particularly those with in-house pharmacy benefit managers, are using access to data on both the medical and pharmacy benefit to develop distinctive insights and better coordinate across pharmacy and medical care. Technology providers, together with a range of both traditional and non-traditional healthcare players, are working to integrate medical and pharmaceutical care in more convenient settings, such as the home, through access to real-time adherence monitoring and interventions. These players have an opportunity to access a broad range of comprehensive data, and advanced analytics can be leveraged to more effectively personalize and target care. Such an approach may necessitate cross-segment partnerships, acquisitions, and/or alliances to effectively integrate the many components required to deliver integrated, personalized, and higher-value care.

Creating and capturing new value

These materials are being provided on an accelerated basis in response to the COVID-19 crisis. These materials reflect general insight based on currently available information, which has not been independently verified and is inherently uncertain. Future results may differ materially from any statements of expectation, forecasts or projections. These materials are not a guarantee of results and cannot be relied upon. These materials do not constitute legal, medical, policy, or other regulated advice and do not contain all the information needed to determine a future course of action. Given the uncertainty surrounding COVID-19, these materials are provided “as is” solely for information purposes without any representation or warranty, and all liability is expressly disclaimed. References to specific products or organizations are solely for illustration and do not constitute any endorsement or recommendation. The recipient remains solely responsible for all decisions, use of these materials, and compliance with applicable laws, rules, regulations, and standards. Consider seeking advice of legal and other relevant certified/licensed experts prior to taking any specific steps.

Before the COVID-19 pandemic, our research indicated that profits for healthcare organizations were expected to be harder to earn than they have been in the recent past, which has been made even more difficult by COVID-19. New entrants and incumbents who can reimagine their business models have a chance to find ways to innovate to improve healthcare and therefore earn superior returns. The opportunity for incumbents who can reimagine their business models and new entrants is substantial.

Institutions will be expected to do more than align with growth segments of healthcare. The ability to innovate at scale and with speed is expected to be a differentiator. Senior leaders can consider five important questions:

• How does my business model need to change to create value in the future healthcare world? What are my endowments that will allow me to succeed?
• How does my resource (for example, capital and talent) allocation approach need to change to ensure the future business model is resourced differentially compared with the legacy business?
• How do I need to rewire my organization to design it for speed? 18 De Smet A, Pacthod D, Relyea C, and Sternfels B, “ Ready, set, go: Reinventing the organization for speed in the post-COVID-19 era ,” June 26, 2020, McKinsey.com.
• How should I construct an innovation model that rapidly accesses the broader market for innovation and adapts it to my business model? What ecosystem of partners will I need? How does my acquisition, partnership, and alliances approach need to adapt to deliver this rapid innovation?
• How do I prepare my broader organization to adopt and scale new innovations? Are my operating processes and technology platforms able to move quickly in scaling innovations?

There is no question that the next few years in healthcare are expected to require innovation and fresh perspectives. Yet healthcare stakeholders have never hesitated to rise to the occasion in a quest to deliver innovative, quality care that benefits everyone. Rewiring organizations for speed and efficiency, adapting to an ecosystem model, and scaling innovations to deliver meaningful changes are only some of the ways that helping both healthcare players and patients is possible.

Emily Clark is an associate partner in the Stamford office. Shubham Singhal , a senior partner in McKinsey’s Detroit office, is the global leader of the Healthcare, Public Sector and Social Sector practices. Kyle Weber is a partner in the Chicago office.

The authors would like to thank Ismail Aijazuddin, Naman Bansal, Zachary Greenberg, Rob May, Neha Patel, and Alex Sozdatelev for their contributions to this article.

This article was edited by Elizabeth Newman, an executive editor in the Chicago office.

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How to Create a Business Plan for a Health Insurance Agency

Why is an agency business plan important, provides direction and focus.

A business plan is like a compass for your insurance agency. It defines your goals, outlines your strategies, and establishes the milestones you need to achieve. This direction helps you stay focused on what’s important, ensuring that every action you take aligns with your overall objectives.

Attracts Investors and Partners

If you’re looking to secure funding or attract business partners, a comprehensive business plan is indispensable. Investors want to see a clear and detailed plan that demonstrates the potential for profitability and growth. A well-prepared business plan shows that you’ve done your homework and are serious about your venture.

Identifies Potential Challenges

Every business faces challenges, and an insurance agency is no exception. A business plan helps you anticipate potential obstacles and devise strategies to overcome them. By thinking ahead, you can mitigate risks and navigate through tough times more effectively.

Sets Benchmarks and Metrics

A business plan establishes benchmarks and key performance indicators (KPIs) to measure your agency’s progress. These metrics allow you to track your performance, identify areas for improvement, and make informed decisions to drive growth.

Ensures Operational Efficiency

Detailed planning helps streamline your operations. By defining processes, roles, and responsibilities, a business plan ensures that your team operates efficiently and effectively, minimizing wasted time and resources.

What Should Be Included in the Business Plan for an Insurance Agency?

Creating a robust business plan involves several key components. Here’s a comprehensive guide to what should be included:

Executive Summary

The executive summary provides a snapshot of your agency. It should include your mission statement, business objectives, and an overview of your strategies. This section should be concise yet compelling to capture the interest of readers, especially potential investors.

Company Description

This section offers a detailed description of your insurance agency. Include information about your agency’s history, the types of insurance products you offer, the market you serve, and your unique selling propositions (USPs).

Market Analysis

Conduct a thorough market analysis to understand the landscape you’re operating in. Identify your target market, analyze your competitors, and outline market trends. This analysis should demonstrate your understanding of the market and justify the demand for your services.

Organization and Management Structure

Detail your agency’s organizational structure. Include information about the ownership, management team, and board of directors if applicable. Describe the roles and responsibilities of each team member and highlight their qualifications and experience.

Products and Services

Provide a detailed description of the insurance products and services your agency offers. Explain the benefits of each product, your pricing strategy, and any unique features that set your offerings apart from the competition.

Marketing and Sales Strategy

Outline your strategies for attracting and retaining clients. This should include your marketing plan, advertising strategies, sales tactics, and customer service approach. Define your brand positioning and explain how you plan to communicate your value proposition to your target market.

Operational Plan

The operational plan details the day-to-day operations of your agency. Include information about your business location, facilities, technology, and equipment. Describe your workflow processes, customer service protocols, and any other operational details critical to running your agency smoothly.

Financial Plan

A comprehensive financial plan is crucial. Include projections for revenue, expenses, and profitability. Provide a break-even analysis, cash flow statement, income statement, and balance sheet. This section should demonstrate the financial viability of your agency and provide a roadmap for achieving financial stability and growth.

Risk Management Plan

Identify potential risks to your business and outline strategies for mitigating them. This could include market risks, financial risks, operational risks, and compliance risks. A proactive approach to risk management is essential for long-term success.

Include any additional information that supports your business plan. This could be resumes of key team members, legal documents, detailed market research data, or technical specifications of your products.

A well-developed business plan is the cornerstone of a successful insurance agency. It provides direction, attracts investors, identifies challenges, sets benchmarks, and ensures operational efficiency. By including the essential components outlined above, you can create a comprehensive business plan that not only lays the foundation for your agency’s success but also positions it for sustainable growth in the competitive insurance market. Start planning today and pave the way for your insurance agency’s prosperous future.

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How to Write a Home Health Care Business Plan

Elon Glucklich

8 min. read

Updated February 7, 2024

Free Download:  Sample Home Health Care Business Plan Template

The world’s population is aging. One in six people worldwide will be 60 years old or older by 2030, and the share of the overall population over 60 will double over the next quarter century, according to World Health Organization estimates .

This demographic shift has driven a surge in demand for custom senior and disability care options. So, if you’re an experienced health care worker with an entrepreneurial streak this presents an opportunity to start your own home health care business.

But the home health care industry is complex and layered—with issues ranging from licensing and staffing to liability concerns. Even with your industry-specific experience, you’ll need to write a business plan to navigate these challenges and focus your time on providing the best care possible.

In this guide, we’ll show you how to tailor your business plan to tackle the complexities of the home health care industry. And you can even download our free home health care business plan template to help get you started.

• Why You Need a Business Plan for Your Home Health Care Business

Do you have a service and staffing plan? Do you know which agency or agencies have regulatory authority over your business? How much funding do you need to pay for equipment?

You’ll need to have answers to these questions and more before launching your business. 

That’s why writing a business plan is necessary when starting any sort of health care business. It ensures that you are thinking beyond your expertise as a health care professional and able to easily manage day-to-day operations, insurance and billing snafus, and extensive startup costs.

You can enter this industry with extensive knowledge and the best of intentions. But without a plan in place, you won’t be prepared to run a successful business. 

• How to write a home health care business plan

For this guide, we’ll be highlighting specific areas that you should focus on when creating a home health care business plan. You can check out or full step-by-step walkthrough on how to write a business plan for additional guidance for creating a detailed plan.

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1. Define your vision

What does your business offer that other health care services in the area don’t?

Answering this question is your first step to lay out a roadmap for your business. And it goes beyond just describing the type of home health care business you will open. This is an opportunity to state your core values , long-term goals and the impact you hope to have on the lives of your clients.

Then, discuss what niche it will fill in the market. For instance, will you open your business to fill a need in an area with few health care options? Or will you round out the offerings in a city with a wide range of services? 

Remember to keep this relatively short. This opportunity section can introduce lenders or investors to the unique services you plan to provide, like specialized care offerings, tailored care plans, or uses of advanced medical technology. But you don’t want them to get bored with an overly lengthy statement. 

You can always go into greater detail about your services in the products and services section of your business plan. 

2. Be specific about your service offering

As a home health care business, you will likely provide a variety of services. But will you have a specific focus—such as elder care or post-surgery care? Or will you offer a wider range of general services like medication management?

Additionally, it’s worth stating if your home health care business will be able to manage requests for specialized services based on individual client needs. 

Whatever you choose, the important thing is to make your service offerings clear and to back them up with market and customer data. Make sure you describe why these services are essential and how they will benefit your clients. And remember to make a clear connection between your services and your target market , which we will go over next.

3. Define who your customers are

Not everyone with a medical condition will be interested in home health care services—so it’s essential that you focus on a specific set of people.

A home health care service specializing in senior or disability care will cater to that specific customer base. But a home health care business that provides post-operative or palliative care would likely appeal to an entirely different market. 

To start your research, try and get an estimate of the population of residents aged 65 and older in the area you plan to serve—which can be found from sources like the U.S. Census Bureau . You may also be able to find the approximate number of nursing and elderly care beds in your area from sources like state licensing records. 

This kind of information will give you a broad sense of how many people you could serve in your area. From there, begin to refine your target audience by taking into account competitors, your services, and what you believe you’ll be able to reasonably handle. 

4. Understand pricing and insurance

When pricing your services, it’s helpful to research the prices of other home health care providers in your area. This provides you with a benchmark and allows you to position your business based on the value and/or quality of your services.  

Now, another factor to consider before solidifying prices is insurance expenses for both your business and patient coverage.

From Medicare and Medicaid to private insurers, you’ll want to document all relevant insurance providers in your business plan. Then, research their reimbursement policies and rates for home health care services to better understand your potential revenue sources.

Different insurance plans may also cover varying degrees of home health care services—with some offering comprehensive coverage and others only covering specific treatments or services. Identify the limitations and requirements of each plan, such as the need for prior authorization or a physician’s referral, to ensure your services are eligible for reimbursement.

Then, make sure you understand the reimbursement rates offered by insurance providers for the services your business will offer. These rates will directly affect your revenue and should be factored into your pricing strategy. 

Just keep in mind that these reimbursement rates may change periodically, so it’s essential to stay up-to-date on the latest information.

5. Identify your staffing and licensing needs

Worker shortages are especially prevalent in the health care industry. Without the right number of employees in the necessary roles, you can expect to see fewer customer visits, worse service quality, and potentially increasing employee expenses. This is why you need to have a well-documented personnel plan that takes into account the roles of your employees, how many you’ll need, and forecast potential expenses.

To start this section, carefully consider the services you plan to offer and the number of clients you expect to serve. That will help determine the number of staff members you’ll need and the qualifications necessary for them to do their jobs well. Additionally, be sure to document any training programs and processes your staff members will receive on topics like client care, safety procedures, and documentation.

Home health care businesses also require a variety of licenses and permits. What’s required may vary depending on your location and the services you plan to offer. So, it’s crucial that you understand the specific requirements in your area to avoid any legal issues down the road. And for your own internal management, it may be useful to detail the local, state, and federal regulations and agencies that will be responsible for regulating your business.

You will need to demonstrate knowledge of the operating requirements in your area to receive a license anyway. So take the extra step of detailing the full range of legal and regulatory issues in your business plan. Otherwise, you raise the risk of facing legal consequences, fines, or even the risk of being shut down.

6. Develop a risk management plan

In such a regulation-heavy industry it’s important to think about–and document–internal and external risks. These can be anything from negligence to malpractice claims and even elder abuse. 

Consider conducting a risk assessment that takes into account your location, services offered, and employee qualifications. Once you’ve identified potential risks, outline what you’ll do to minimize or avoid them altogether. For example, you can implement employee training programs to prevent theft or malpractice, or you can invest in insurance to protect your business from liability claims.

By protecting your business from potential risks, you can increase your chances of success and longevity. And you can show lenders, investors, and regulators that you have considered the risks and developed the right strategies if they arise.

7. Marketing and PR

As home health care demand rises competion is bound to rise with it—especially if you plan to operate in an urban area where consumers are more likely to have multiple options. As part of your plan you need to not only take your competitors into account but outline how you will raise awareness and attract customers.

Some strategies to consider include:

• Creating a website or online portfolio that showcases your services and provides potential clients with your contact information.
• Using social media platforms to communicate directly with clients, and keep them informed about your services and any special offers.
• Investing in advertising by targeting your ideal clients through print or digital media.
• Partnering with other businesses, such as senior centers, to expand your reach and offer added value.
• You can also consider hiring a PR consultant, but make sure they have experience with home health care businesses or similar industries.
• Download a free home health care business plan template and example

To help get you started on your home health care business, check out our free home health care business plan template . You can download this document in Word form and use it as a foundation for your own business plan.

In addition to these resources, you may want to brush up on how to write specific sections of a traditional business plan. If so, take a look at our step-by-step guide on how to write a business plan .

Elon is a marketing specialist at Palo Alto Software, working with consultants, accountants, business instructors and others who use LivePlan at scale. He has a bachelor's degree in journalism and an MBA from the University of Oregon.

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Pet insurance is a ripoff

How poor little Fido and Fluffy are being denied healthcare because of 'preexisting conditions.'

Gina Papini honestly isn't sure whether she got taken for a ride on pet insurance , but it's pretty clear she didn't get much bang for her buck.

Papini and her husband decided to add coverage for their two dogs and their cat when it was offered in 2021 as a bundle with their home-insurance plan. It seemed like a simple way to protect their pets' health. But the whole endeavor wound up being a headache. The pets' combined premiums cost hundreds of dollars a month, she says, and the coverage proved far less comprehensive than they anticipated. The couple never really needed to use the insurance for their two younger animals, and for their older dog, Kato, the process was a mess. Whenever Kato wound up at the vet, usually with stomach issues, they'd pay the bill and then submit it to the insurance company, which would then balk at reimbursing them.

"We thought it would save us money in the long run if we got it, but then they would refute claims and say, 'Well, this could have been a preexisting condition,' and preexisting conditions aren't covered," Papini said. "You need extra vet paperwork to back up that it wasn't. And so then you just get to a point where you're jumping through so many hoops."

Papini and her husband got tired of dealing with all the rigamarole and axed their insurance plan after a year. Despite paying thousands of dollars in premiums, they never saw a single reimbursement.

People love their pets , and they're willing to do a lot for them, financially and otherwise. The American Pet Products Association has estimated that Americans spent $147 billion on their animals in 2023, including $38 billion on their healthcare. This level of attachment has helped turn the pet insurance industry into a lucrative and rapidly expanding market. The North American Pet Health Insurance Association found that pet owners in the US paid $3.9 billion in premiums in 2023, a 22% increase from the year before. Some 6.25 million pets in the US were insured as of the end of 2023, per NAPHIA. That's still a small fraction of all the pets in the country, given that there are over 80 million pet dogs and 60 million pet cats, according to the American Veterinary Medical Association. But it's growing.

As pet insurance becomes more prevalent, so too do the questions about it. While some people swear by it, others think it's a scam. One thing is for sure: As the industry grows, pet insurance is becoming as confusing and messy as health insurance is for humans. It's barely regulated, and deciphering what it does and doesn't encompass can be super confusing. Just like regular health insurance , coverage for pets often winds up being riddled with loopholes and fine print that allows insurers to deny claims, declining to pay for the very care that motivated consumers to buy the policy in the first place. Because consumers pay up front, they often don't realize they won't be reimbursed until it's too late. Pet insurance gets pricier over time, meaning many people can no longer afford to keep their coverage just when they might start to need it.

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In short, pet insurance isn't a grift — some people do end up using their benefits. But for many people, insuring their furry friends ends up being a money suck.

Pet insurance isn't technically even health insurance; it falls in the property-and-casualty category. It's generally regulated pretty lightly by states. There are no broad federal regulations around it, and only a handful of states have laws and standards around it specifically. How it usually works is people pay a monthly premium, and after they've paid a vet bill, they submit it to the insurer to try to get their money back. Just as with human health insurance, there are also deductibles and copays and annual limits on how much the policy will pay out.

The big problem with pet insurance is it's just an expensive product

There are three categories of pet insurance: accident only; accident and illness; and accident, illness, and wellness. Adding more coverage makes the policy more expensive. Accident and accident-illness policies cover costs only if something goes awry — Rover gets into a rough fight at the dog park or develops arthritis. Fancier, more-comprehensive policies also cover wellness visits and preventive care, like dental care and vaccines. No matter the policy you choose, insurance can get expensive fast . Premiums generally go up each year as a pet gets older. And as with many insurance products , pet-insurance premiums across the board are on the rise because of inflation and the increasing cost of care.

"The big problem with pet insurance is it's just an expensive product," said Kevin Brasler, the executive editor of Consumers' Checkbook, a consumer watchdog group. "If you're going to be one of these plans, buy it when your pet's young, but just know your costs are likely going to skyrocket as time goes on."

Even if a pet owner can find an affordable policy, they may have trouble deciphering what's covered. Pet insurance almost never covers preexisting conditions , and what qualifies as preexisting can be quite broad and hard to parse. (It's wild that we used to do this for people , by the way.) If you get a policy for your puppy before it has a chance to develop any problems, it might be a good deal. But if you have a 10-year-old dog with diabetes, that's a different story. I got some quotes from the website Pawlicy Advisor for my fictional dog, a mixed breed named Dan. When I changed the inputs to make Dan a six-month-old in optimal health, the platform recommended a policy starting at $28 a month. When Dan was 10 and had some issues, the first policy it suggested was $125, and some plans were about $350.

Michael San Filippo, a spokesperson for the American Veterinary Medical Association, said in an email that the group endorsed the "concept" of pet health insurance, which can help keep vet costs down and save animals' lives, but he acknowledged that when the rubber hits the road, it can get hard to figure out.

"It's important that pet owners understand the scope of what their pet insurance does and does not cover, so they're not caught off guard by unexpected payments," he said.

Even getting good advice on which pet-insurance policy is right for you can be a challenge. There are endless listicles recommending various policies, as well as websites dedicated to comparing insurers. The sheer volume of information can be hard to parse. It's also difficult to differentiate what is genuine advice and what's paid for. Many comparison tools get commissions for sales made through their platforms, so what they're recommending may not actually be the best option — it's just the one they'll make money off of . (This is true for all sorts of platforms that compare and recommend financial products, from credit cards to travel insurance.)

This new structure has been a detriment to the industry with profit as the primary motive versus what is in the best interest of the consumer

The spread of these lists also points to another problem with the industry: the corporatization of pet insurance. Doug Kenney, a retired veterinarian who writes about the pet-insurance industry, said in an email that a decade ago, most pet-insurance companies were considered small businesses and were led by a founder/CEO with a vision for the company. Over time, these companies took on larger corporate structures, and some founders were pushed out by their boards. Nowadays, there are many large pet-insurance companies, some of which specialize only in pets, others of which are larger insurers that offer pet insurance, and many of which are publicly traded, meaning they ultimately answer to shareholders.

"This new structure has been a detriment to the industry with profit as the primary motive versus what is in the best interest of the consumer," Kenney said. "I used to say that pet insurance was a win, win, win proposition with the insurance company, veterinarians, and the policyholders and their pets all benefiting. I don't think that's the case anymore."

Reporting this story, I fully expected to come down on one side or the other on whether pet insurance is good or bad. But I really didn't come up with an answer. I heard about a wide array of experiences with pet insurance, from awesome to mediocre to awful. One woman saved $4,000 on vet bills thanks to her insurance after her cat ate a pom-pom toy and the doctor had to fish it out. One man looked into getting coverage for his two cats after learning that both had extra teeth, but the minute they were documented, those overcrowded mouths became a preexisting condition. Another woman adopted a dog from Mexico with a "pretty wonky leg" that's "very noticeable." At her first vet appointment with the animal, the doctor told her to apply for pet insurance. She said she wouldn't note the leg on the dog's chart so the application would be approved — everyone agreeing to do a light amount of insurance fraud .

It's not likely to save you money down the road, and if it does, you're an outlier.

In a purely financial or economic sense, pet insurance seems pretty worthless for many consumers. There are too many exceptions, too many hoops to jump through, and little regulatory recourse if you think you got taken for a ride. Unless something goes really awry, people pay more into their policies than they get out of them. Brasler was pretty blunt in his assessment of the overall product.

"You really need to think carefully about 'What kind of pet owner am I?' No judgments," he said. "This is a really expensive product. It's not likely to save you money down the road, and if it does, you're an outlier."

Ultimately, a lot of the value of this sort of insurance is emotional. It's possible to do some back-of-the-envelope calculations to figure out the lifetime cost of a policy, but the personal side of the equation is considering how much you're willing to spend on your furry friend. Maybe you feel like spending $10,000 over the course of your pet's life on insurance is worth it for the peace of mind. Or maybe you forgo insurance, figuring that if your companion has a serious health problem, you'll make the decision then to spend the money on them — or not. (Again, no judgments!)

As for Papini, she's not getting back on the pet-insurance train. It was just too hard to deal with, and her husband is still cranky about the ordeal. She knows they're fortunate to be able to pay out of pocket for their animals' needs, which remain expensive. Kato now has cancer, and the treatments cost thousands of dollars. Would the insurance be worth it now? It's hard to know.

"Who's to say they wouldn't have been like, 'Well, he had diarrhea in 2017, so therefore it's a preexisting condition,'" she said. "Then we would've spent thousands of dollars for the insurance, never been able to use it, and still had to pay out of pocket on top of it."

Emily Stewart is a senior correspondent at Business Insider, writing about business and the economy.

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Los Angeles County launches ambitious plan to tackle medical debt. Hospitals groan.

The nation’s most populous county, los angeles, has worked for more than a year on a plan to track and tackle patient debt and hospital collections..

LOS ANGELES — Los Angeles County has launched one of the most ambitious efforts in the nation to tackle medical debt, targeting hospitals for their role in feeding a $2.9 billion problem.

For over a year, the nation’s most populous county has worked on  a comprehensive plan  to track patient debt and hospital collection practices; boost bill forgiveness for low-income patients; and buy up and forgive billions in medical debt — an effort helmed by its Department of Public Health.

Though LA County isn’t the first government entity to confront this crisis, what sets it apart is how it casts medical debt not as a political issue, but as an urgent public health threat as prevalent as asthma and diabetes.

“Nobody in the county of LA who is facing economic limitations should have that impact their ability to get the kind of health care, the kinds of services and support that we all need and are essential to optimal well-being,” public health department director Barbara Ferrer said at a  medical debt symposium April 10 .

Mona Shah of Community Catalyst, a national health equity and policy organization, called the county’s efforts bold — tackling the root causes of medical debt, in addition to providing immediate debt relief, with input and participation from health plans, hospitals, community organizations, and government partners. Shah said the county’s population of about 10 million adds to the significance of its initiative.

But on the eve of the symposium, the local hospital association called on the county to revise its plan.

“We believe the proposed DPH [Department of Public Health] debt relief program and data collection effort will only burden hospitals with unnecessary requirements, without ultimately helping to address the underlying issue,” wrote George Greene, CEO of the Hospital Association of Southern California,  in a letter  to the LA County Board of Supervisors.

Many of the county’s recommendations would require hospitals to change their processes and add reporting duties. For instance, the county is asking hospitals to inform it when patient debt is sent to collections and pressing hospitals to improve access to financial assistance programs. Although state law requires hospitals to provide assistance, patient advocates say many don’t make it easy for patients to access.

Adena Tessler, LA County regional vice president for the hospital association, told KFF Health News the industry provides ample financial assistance and that the county is putting too much emphasis on hospitals’ role in the debt crisis, when other sectors of the health care system, such as insurers, should share the blame.

Tessler said the county plan should include all players, including health plans, provider groups, and ambulance providers.

“Medical debt is a problem, and we want to be a part of the solution,” Tessler said. “But hospitals are not the only source of medical debt.”

Medical debt affects 4 in 10 adults in the U.S., according to  a KFF Health News analysis . LA County found, in its own analysis this year, that about 785,000 residents were burdened in 2022 with a total of  $2.9 billion  in medical debt.

The county analysis shows that medical debt disproportionately affects people of color, low-income people, and families with children. Having medical debt more than doubled the likelihood that patients would delay or forgo health care or prescriptions or be at risk of losing housing or going hungry.

Nationally,  a handful   of states  have passed rules to limit medical debt collection or bolster hospital financial assistance policies. Some jurisdictions have  relieved residents of debt . Connecticut, Colorado, and New York enacted laws in the last two years to ban medical debt on credit reports, which can depress credit scores and make it harder for patients to get a job, rent an apartment, or secure a car loan. California lawmakers  have proposed  similar legislation, and the federal Consumer Financial Protection Bureau  is also developing  a set of rules.

“It’s a huge public health problem,” said Naman Shah, medical and dental affairs director at the public health department. “We in public health try to shift the determinants of health. Those are things that impact health deeply and impact people widely. Medical debt fulfills both of those. It’s important that we see this as a health issue, and not just a regulatory issue.”

The department made initial  recommendations last spring , then further developed them with the backing of the Board of Supervisors, which  described medical debt  as “pervasive” and “causing financial, mental, and physical harm … especially to those from historically marginalized communities.”

Shah said that while the department continues to take hospital input and has addressed some of the association’s “misunderstandings,” officials are moving ahead with the plan. Tessler agreed the focus is on collaboration, not halting the county plan.

Over the next several months, the county plans to score hospitals based on financial assistance accessibility and provide them with templates and guidelines to make financial assistance less confusing and less burdensome for patients.

States such as Washington, Oregon, and Maryland have developed similar materials for hospitals.

The county’s goals also call for other debt prevention strategies, including working with plans and providers to better educate consumers to avoid surprise billing and out-of-network charges.

Shah said he was surprised by the timing of the hospital association’s letter, especially since county officials and hospital representatives met several times before the April symposium. He agreed it is important to tackle all sources of medical debt but said hospitals are a reasonable place to start. Nearly 75% of adults with medical debt owe some or all of it to hospitals, according to a  2023 Urban Institute analysis .

“We want to get the most bang for our buck,” Shah said. “The largest bill that a patient receives is not a dental bill. It’s not an office bill. It’s a hospital bill.”

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source for health policy research, polling, and journalism.

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Senators See Possible Conflicts of Interest in Health Care Pricing Tools

A data analytics firm that helps insurers collect big fees while leaving some patients with unpaid bills has been summoned to explain its business model.

By Chris Hamby

Chris Hamby has been investigating the lucrative business of out-of-network medical claims.

The chairmen of two Senate committees overseeing health policy, concerned about companies “padding their own profits” at the expense of patients, are looking into the practices of a data analytics firm that works with big insurers to cut payments to medical providers.

The firm, MultiPlan, recommends what it says are fair payments for medical care, but the firm and the insurers can collect higher fees when payouts are lower. This business model could “result in an improper conflict of interest,” the chairmen of the two committees, Ron Wyden of Oregon and Bernie Sanders of Vermont, wrote in a letter to the firm’s chief executive that was released on Tuesday.

The senators called on MultiPlan to meet with the committees’ staffs to discuss an investigation last month by The New York Times that found the firm’s pricing tools could leave patients with unexpectedly large bills when they see doctors outside their health plans’ networks.

“Our committees are engaged in ongoing legislative work to put a stop to practices by plan service providers that drive up health care costs for consumers while padding their own profits,” the letter to Travis Dalton, the MultiPlan chief executive, said.

In a statement, MultiPlan said it was working with the Senate committees “to address their questions and explain the cost and complexity patients can face” when choosing high-priced care outside their networks. “We are committed to helping make health care transparent, fair and affordable for all,” the statement said.

The committees’ inquiry reflects growing scrutiny of the New York-based firm, which has largely remained out of the limelight even as it has staked out a dominant position in a lucrative corner of health care.

Another senator, Amy Klobuchar of Minnesota, this month asked federal antitrust regulators to investigate whether insurers and MultiPlan were colluding to fix prices, and multiple health systems have sued the firm, accusing it of similar anticompetitive behavior.

Separately, the Department of Labor said Tuesday that it had “a number of open investigations” into the type of pricing services MultiPlan provides, but declined to name specific companies. The agency, the primary regulator of employer-based health insurance, stressed in a statement that companies were legally obligated to ensure the firms processing medical claims acted in their employees’ best interest.

The letter from Mr. Wyden, a Democrat, and Mr. Sanders, an independent, also steps up attention on employer-based health insurance, which is the most common way Americans get coverage and a major component of MultiPlan’s business.

As health care costs climb, some employers are looking more closely at what they pay insurance companies to administer their plans, but they are often frustrated by contracts that limit access to their own claims data. To address this, a bipartisan group of senators, including Mr. Sanders, introduced legislation in December that would require insurers to turn over this data .

“Most businesses do their best to manage the ever-increasing cost of their group health plan, but it should be easier,” Senator Mike Braun, an Indiana Republican and cosponsor of the bill, said in a statement.

A majority of employers choose to pay medical claims with their own money and use an insurer to administer their plans. This setup, known as “self-funding,” can be lucrative for insurers like UnitedHealthcare, Cigna and Aetna, as well as specialized firms like MultiPlan.

The insurers pitch MultiPlan’s tools as a way to save employers money when their employees see a medical provider outside the plan’s network. The bills for these out-of-network providers are subject to negotiation, and insurers often send the claims to MultiPlan, which recommends an amount to pay.

Both MultiPlan and insurers typically collect a fee from the employer based on the size of what they call the “savings” — the provider’s list price minus the recommended payment. Lower payouts can mean bigger fees. Meanwhile, patients can be stuck with the unpaid balance, The Times investigation found.

Companies are legally obligated to ensure the insurers act in employees’ best interest, and a closely watched lawsuit filed last year could force them to become more active monitors.

A worker at Johnson & Johnson sued the company, saying it had failed to adequately oversee the administrator of its drug benefits plan. By paying too much — in one instance, $10,000 for a drug that was available for as little as $28.40 — the company had allowed the administrator, the Cigna subsidiary Express Scripts, to profit at employees’ expense, the suit claimed.

In a statement, Johnson & Johnson called the claims “meritless” and said, “We are committed to our employees and seek to provide the best coverage.”

A small industry of consultants, lawyers and data analysts has arisen to help companies step up monitoring and negotiate better deals with the insurers administering their plans.

Kraft Heinz last year sued Aetna, claiming the insurer improperly paid claims and kept millions in undisclosed fees. Trustees for a union health plan in Massachusetts sued Blue Cross Blue Shield of Massachusetts in 2021, accusing the insurer of repeatedly overpaying claims and then charging a fee to correct the errors. And in January the Department of Labor sued Blue Cross and Blue Shield of Minnesota, claiming the company forced multiple employers to pay medical providers’ tax bills without disclosing the charges.

(Aetna declined to comment on the case but said it worked with employers “to facilitate access to quality, affordable and convenient health care.” Blue Cross and Blue Shield of Minnesota said the government’s allegations were “without merit” and “based on unsupported interpretations” of the law. A court dismissed the Massachusetts case.)

The success of the employers’ efforts sometimes hinges on an unsettled legal question: Does a company’s duty to act solely in its employees’ best interest extend to insurers and firms like MultiPlan? Courts have reached different conclusions.

MultiPlan has argued that the answer is no, and in March a federal judge in California agreed, dismissing the company from a lawsuit filed by medical providers. The case against the insurer, Cigna, was allowed to go forward.

In pitches to investors, MultiPlan has highlighted its murky legal obligations. Because the firm doesn’t provide insurance or pay claims, it noted in a public filing, “we generally are not directly regulated and face significantly lower levels of regulatory complexity.”

Chris Hamby is an investigative reporter for The Times, based in Washington. More about Chris Hamby

Our Coverage of Congress

Here’s the latest news and analysis from capitol hill..

Departing House Members: A wave of House retirees from both parties, including committee chairs and rising stars, say that serving in Congress is no longer worth the frustration .

Cuellar Investigation: The House Ethics Committee has launched an investigation  into Representative Henry Cuellar, Democrat of Texas, over allegations that he accepted bribes and committed misconduct in office.

Border Deal Fails Again: Senate Republicans blocked a bipartisan border enforcement bill  for a second time this year. The vote amounted to a political trap  laid for Republicans by Senator Chuck Schumer, the majority leader.

Noncitizen Voting Law: The House passed legislation that would undo a District of Columbia law allowing noncitizens to vote  in local elections, part of a broader G.O.P. bid to amplify false claims of widespread illegal voting by immigrants.

A New Centrism Rises: The emergence of a new form of American centrism — call it neopopulism  — has made the last four years arguably the most productive period of bipartisanship in Washington in decades.

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OPEC+ agrees to extend voluntary output cuts into Q3'24, talks continue, sources say

OPEC+ has agrees to extend voluntary oil production cuts of 2.2 million barrels per day into the third quarter of 2024, two OPEC+ sources said on Sunday.