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Compare Group and Individual Health Insurance

Updated: Jul 16, 2014

Highlights

  • Understand that group health insurance is available only if you are a member of a qualified group.
  • Weigh your health risks, to choose the best policy.
  • Consider portability of your policy, when choosing between a group or individual plan.
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Group Health Insurance vs. Individual Health Insurance

Deciding which insurance plan is right for you and your family is challenging. It is like going into a supermarket where you have never shopped before. You don’t know what is in each aisle or how to find what you need. 

The best way to find health insurance that fits your needs is to list out the choices that are available to you and look at each option’s advantages and disadvantages.

Group vs. Individual Health Insurance Plans

A first step is to decide if you will take out an individual or a group health policy. Group insurance is only an option for you, if you are a member of a group that offers a group health policy. Common groups that offer  insurance are employers, unions, and trade associations. The most common form of group insurance in the US is insurance offered by an employer. Employers frequently offer insurance because the employer gains tax benefits from offering subsidized care and increases the overall health of the employees. Even if you have the possibility to get group insurance, you want to consider whether it is a better choice for you than a health insurance policy you can purchase as an individual.

If you are not a member of an eligible group, your only choice is to seek individual insurance. Individual or family insurance is insurance that you purchase independently and are personally responsible for sending in the monthly premium payment. Individual insurance can be purchased for a single person or a family. You may think that you will spend more money to buy an individual insurance policy, but that is not necessarily the case. Compare the different options available and find the one that meets you or your family’s needs for proper coverage and affordable cost.

Advantages and Disadvantages of Group Health Insurance Plans

There are pluses and minuses of group insurance that you should consider, so you can make an informed choice. Here are some advantages of group insurance offered through your work:

  1. A primary advantage of a group insurance plan offered by your employer is that the employer is paying part of the cost. Anything that you do not have to pay, reduces your costs, making insurance more affordable for you.
  2. You receive a tax benefit, because you don’t need to declare as income the portion of the policy premium that your employer pays.
  3. You are not subject to individual underwriting for the policy. If you have any pre-existing conditions, a group policy makes great sense. You are not judged for eligibility based on your health.

The primary disadvantage of a group insurance policy is that your insurance coverage can end if you are no longer part of the group. If you leave your job or lose your job, your employer based coverage will end. This can affect you when you retire, too. While there are ways of extending your coverage if your employer based coverage ends, they are costly and temporary.

Advantages and Disadvantages of Individual Health Insurance Plans

There are pluses and minuses of individual insurance that you should consider, too.

  1. If you are healthy, it may be cheaper to purchase insurance on your own. In a group policy, they have averaged high-risk and low-risk people together.
  2. You can choose coverage that fits your specific needs. Your monthly premium may not be cheaper, but you can purchase an individual policy that meets you and your family’s needs for prescriptions and medical care that will save you money over all.
  3. A major plus of an individual insurance plan is that it is portable. You can leave your job without any concern that you are jeopardizing your health care. You do not have to qualify for new insurance, the way you would if your group health terminated, so you are not at risk for losing coverage if you have become high-risk.

The main disadvantage of applying for an individual health insurance policy is that you can be turned down because of your health, due to the individual risk-assessment that the insurance provider makes. Higher risk will mean higher cost; you don’t want an individual policy if you are high-risk and a group policy is available.

Once you choose whether a group or individual policy is best for you and your family, then read the Bills.com article about choosing between a managed care plan or an indemnity/fee-for services plan. 

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