Health Insurance Through Employer vs. Personal: Key Differences

The Affordable Care Act (ACA) passed in 2010 has provided a new option for buying health insurance – the ACA Marketplace. If you have an employer that offers health insurance, you may wonder if it is better to get your insurance through them or buy your own plan – a “personal plan" – on the Marketplace. Here is more information to help you decide.

How Does Employer Group Health Insurance Work?

As the name suggests, group health insurance plans cover multiple people — typically employees. Members of group health plans get reduced rates due to the number of people they bring to an insurer and because the risk is spread among many individuals.

Employers often pay a portion of the policy's premiums as a benefit, further reducing the cost to the individual. For an added cost, health insurance coverage can usually be extended to spouses, domestic partners, and employee dependents.

Organizations such as the American Association of Retired Persons (AARP), the Freelancers Union, and wholesale membership clubs may also offer group plans.

Personal Health Insurance

If you are not covered through work or are self-employed, you have a few personal health insurance options:

HealthCare.Gov

HealthCare.Gov is the internet home to information about the Affordable Care Act. Here you can buy health insurance on the Federal Health Insurance Exchange, also called “the Marketplace." Depending on your income you may qualify for subsidies so you will pay less for coverage.

State Health Insurance Plans

Some states offer their own State Health Insurance Plans, usually for those who qualify for Medicaid, or for children via the Children's Health Insurance Program (CHIP). Find out if your state has its own health insurance marketplace here.

Medicare.Gov

Medicare.Gov has information on the federal health insurance program for those ages 65 and older. Visit the site to learn what Medicare covers and if it is the right choice for you.

Private Health Insurance

If neither the Marketplace nor Medicare is an option for you, you can buy “individual plans" from many health insurance companies. You can find information on their websites, however, you may not get a good sense of what you will be paying, since many companies post only the lowest available plan price. You may also contact a health insurance broker who can help you choose a plan. Brokers often represent several insurance companies and work on commission.

Considerations When Buying a Health Insurance Plan

A few things to consider when selecting health insurance coverage include:

• The cost of the plan (premium)
• Whether the health care providers you want to use are in-network
• Deductibles, copays, and coinsurance
• Out-of-pocket maximums
• Levels of coverage once you meet the deductible
• Prescription drug coverage
• Pregnancy benefits
• Hospital coverage
• Vision and dental coverage
• Specialty coverage such as for physical therapy or chiropractic care

Managing Healthcare Costs with CareCredit

If you are looking for an option to help manage your medical bills, consider healthcare financing with the CareCredit credit card. The CareCredit card can help you pay for the care you want and need and make payments easy to manage.* Apply today and use our Acceptance Locator to find a provider near you that accepts CareCredit. Continue your wellness journey by downloading the CareCredit Mobile App to manage your account, find a provider on the go, and easily access the Well U hub for more great articles, podcasts, and videos.

Our Expert Reviewer

Patty Caballero and her team of consultants together have more than 35 years of health insurance knowledge working for some of the biggest health insurance companies in the US. She has knowledge in building brands and strategic initiatives to help consumers better understand their health benefits.