Employer (Group) vs. Individual Health Insurance Plans

Group vs. Individual Health Insurance


Many employers offer health insurance to their employees and their dependents through group or employer-sponsored coverage. An employee can choose group or individual health insurance based on their budget and healthcare needs. Consider the differences in cost and coverage in health insurance through your employer vs. individual insurers.

How Are Group and Individual Insurance Different?


Group health insurance

  • Employers often pay a portion of your health insurance monthly premium
  • Choice of in-network doctors and hospitals will vary, depending on the plan or plans offered by the employer
  • Coverage and network can change if you switch employers 

Individual health insurance

  • Enrollees may be eligible for government subsidies to lower their monthly premium and out-of-pocket costs
  • Choice of preferred doctors and hospitals depends on the plan you choose
  • Coverage stays the same even if you change employers


Group Coverage vs. Individual Health Insurance Costs

The costs of an individual and family health plan versus an employer-sponsored group plan can vary depending on several factors. Individual and family health plans can be impacted by income and where you live, while employer-sponsored group coverage depends on employment status and if your employer offers a health plan.


Cost benefit of an employer-sponsored group health plan

The premium cost is usually shared between your employer and you, which helps you save money.


Cost benefit of an individual and family health plan

You may be eligible for a subsidy from the federal government to help lower your premium and out-of-pocket costs.


When To Consider An Individual Health Insurance Plan

You may want to consider an individual and family health insurance plan when:

  • You are self-employed, a contractor, work part time, and are ineligible for employer-sponsored coverage
  • Your employer does not offer health insurance to its employees
  • A Health Insurance Marketplace plan is more affordable than the health coverage offered by your employer


When To Consider A Group Health Insurance Plan

You may consider an employer-sponsored health insurance plan for you and your family when:

  • Your employer offers plan options that you can choose from that fit your coverage needs and budget
  • Your employer shares the cost of monthly premiums with you to save you money on health coverage
  • The health coverage offered by your employer is more affordable than Marketplace options


Can You Buy A Marketplace Plan If Your Employer Offers Insurance Coverage?

You can choose an individual and family Marketplace health insurance plan instead of your employer-sponsored coverage. However, if your employer-based health plan is considered affordable and meets minimum coverage standards — as most employer health plans do — you won’t qualify for a premium tax credit or other savings available on the Marketplace.


You can enroll in an individual and family health insurance plan from the Marketplace during the annual Open Enrollment Period. Or, if you experienced a life event such as losing a job or moving, you may qualify for a Special Enrollment Period, which allows you to sign up for a health insurance plan sooner. 


We Can Help You Navigate Your Health Insurance Options

Count on our experience and support to enroll in health coverage. We can help you choose a health insurance plan with Anthem and guide you through the process.

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