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Health Insurance Basics

Understanding the Difference Between Group vs. Individual Health Coverage Plans

March 13, 2018

When it comes to group vs. individual plans, you probably know the basics: Health insurance that an employer provides its workers is group coverage. Health insurance that someone buys on their own is individual coverage. But what makes one plan better than the other for you? Let’s take a deeper dive to understand the differences.

Under the Patient Protection and Affordable Care Act, there are minimum standards for individuals and companies regarding healthcare coverage. Most employers with 50 or more employees must offer health care plans. Self-employed individuals who do not work for an organization full-time also must have coverage, according to HealthInsurance.org.

What to Expect from Employer-Sponsored Coverage

Of Americans who have health coverage, nearly 60 percent have a group plan, according to HealthInsurance.org. If you’re in this majority, here’s what you can expect from employer-sponsored coverage.

Your employer may:

  • Include a range of plan options, including HMO, PPO, or additional coverage options, including dental, vision and life insurance.
  • Be responsible for a significant portion, or all, of your monthly premium.
  • Deduct the share of your premium from your paycheck each pay period.
  • Provide additional assistance through their human resources department, where you can access documents relevant to your plan and direct questions about coverage.
If You Don’t Have Group Coverage, What Can You Expect from Individual Coverage?

Americans without group coverage fall into the individual health plan category. With individual coverage, you’ll likely:

  • Choose a plan that covers you and your family, and pay the monthly payments.
  • Plan on enrolling during an open enrollment period. You can only enroll at other times of the year if you qualify for special enrollment.
  • Determine if you qualify for cost assistance also known as (Subsidy eligible).
  • Select from Bronze, Silver, Gold or Platinum plans through the health insurance marketplace, through a broker, or directly from a carrier if you are not subsidy eligible.
Resources to Help You Choose an Individual Health Plan

Sometimes navigating through individual health plans on your own can be difficult, so we’ve rounded up a list of helpful resources to help:

Having the proper health insurance for you and your family is important. Understanding your options when you don’t have an employer plan can be confusing. Take the time to educate yourself so you can choose the right plan for your family.

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