Group vs. Individual or Family Health Insurance

Trying to determine what insurance you or your family need or qualify for can be a struggle. Do you need employer group insurance, private insurance, or Obamacare insurance? Obviously, if you can’t get health insurance through your employer, you’ll want to explore the individual health insurance options. But what if you can get health insurance through your employer? Could you score a better rate by waiving coverage? BE VERY CAREFUL!

Keep reading to find out why.

Group Health Insurance

Group health insurance coverage is a health insurance policy that is purchased by an employer and is offered to employees (and typically to the employees’ family members) as a benefit of working for that company. It is usually part of a comprehensive benefits package that employers provide for employees.

Millions of Americans have health insurance coverage through their employer or the employer of a family member. Typically, employers will pay a minimum of 50% (but can pay up to 100%) of the monthly premium for an employee, but may elect to pay for spouse and dependents. Your employer is only obligated to pay 50% of your (employee) premium, but may elect to pay for more, but they are not required to do that. The group insurance plan, however, has to offer it to the spouse and dependents, but isn’t required to pay for them. They may offer to do so, but again, they are not required to. The portion that you do pay is taken from your pre-tax earnings, which will add up to significant savings for you.

In a vast majority of cases, sticking with the group health insurance plan offered by your employer is your best bet. With a group health insurance plan, you may have access to benefits that you wouldn’t be able to afford with an individual health insurance plan.

As of November 2022, now the spouse and dependents MAY qualify for a government subsidy, even if the employee is offered coverage. It depends on how much the premium is compared to household income. Click here for more details: Have You Been Offered Health Insurance At Work?

An employer can offer one plan or several plans, and sometimes they’ll offer a group dental and vision plan also. The employer selects the plan they offer the group, not the employees. Once a year the insurance will renew the policy, and the group will have “Open Enrollment” for their employees which will happen one month before the group insurance plan renews. This is a critical time for the employee to make decisions about whether they want to participate in the group insurance or not. If the employee misses out, they may not have insurance until the next “Open Enrollment” for the group.

Typically, if your employer offers group health insurance, your coverage will start shortly after your hire date, so you don’t have to worry about a long gap in coverage while you wait for the Open Enrollment Period. If you do have a 30-to-90-day window before your benefits kick in, we can help you with a “Short Term Health Insurance Plan”.

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Private Health Insurance

Not everyone has access to employer-subsidized group health insurance. Luckily, you can get comprehensive, affordable coverage by purchasing health insurance through Nevada Health Link (and most likely qualify for Government assistance to help you pay your premiums).

When an individual or family shops and selects their own health insurance policy, whether the coverage has a government subsidy or not, this is a private health insurance plan. A major medical plan will cover your medical bills, hospitals, surgery, doctors, labs, prescriptions, mental health, maternity, preventive visits, etc.

You can also buy a qualified health insurance plan “off exchange” meaning your plan is going to cover all the benefits offered through Nevada Health Link, but you are buying the insurance through the insurance company without any government assistance. Many times you’ll have additional options you won’t have through Nevada Health Link.

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