Individual Health Insurance Versus Group Health Insurance - A Guide to the Differences in the Plans

Individual Health Insurance Versus Group Health Insurance

When shopping for medical insurance it can be difficult and intimidating when trying to determine what policy and plan is the best one for you. Health insurance rates are not the same in each state. This is also true when you consider the options of getting your medical insurance through your employer or buying an individual insurance plan. There are many factors that play into what, where and for how much you can get the best deal. Two different options that you can look at are individual insurance and group insurance.

With individual health insurance, you must apply for health coverage directly with the insurance provider. The rate will be based on your health history and can be rather expensive. Most people have their insurance provided for them through their employer or government program. However, about five percent of the population obtains medical care coverage through individual plans.

Group insurance differs in that the insurance provider groups individuals together by company or organization and offers a lower rate to the group. This type of insurance is offered by employers to qualifying employees as a benefit for working for the company. Group health insurance is by far the most common in the United States.

An important difference between individual and group plans is how you must qualify for either individual or group insurance. If you want to purchase individual insurance you must first qualify. This includes participating in a medical examination as well as completing a health questionnaire revealing any health issues that you may already have. The results are evaluated and used as a deciding factor as to whether or not you are insurable. This can be frustrating because you may be turned down due to your age, income, habits and medical history. Group insurance works differently in that an insurance company is incapable of refusing you insurance when company group coverage is involved. If you tend to have poor health or negative habits (such as smoking), group insurance may be the best option for you.

Along with qualifications, the cost of your coverage is extremely important when considering your options. With individual coverage you are likely to have a higher deductible, which is the amount of money per year that you must pay in advance of the insurance company paying for your health care. Individual insurance also has a higher co-pay or cost-sharing expense. Cost-sharing is a fee you pay at the time of service directly to the medical practitioner. With group coverage, your overall out-of-pocket expense will be significantly less than your costs with individual insurance. Group insurance rates can be more easily reduced because there are more people and the risk that the insurance company is taking can be spread out over multiple individuals. With group health insurance, the employer pays the largest amount money to the insurance company. This means that employees receiving the benefits are left with only a fraction of the cost.

Now that you know the basics of who qualifies for what and the associated costs, let's now discuss some other important facts involved with purchasing insurance. The benefits of each particular health plan, for example, are something that you should consider. If you're going to be paying for something it's important that you benefit from it and that it's not going to be a waste of money. In the case of a group policy the employer is the one that makes the decision on what benefits will be offered. Everything that is or is not covered is determined by the employer and will ultimately determine the amount of your premium. The plan that your employer selects could actually offer you a lot of things that you don't actually need but still end up paying for. In the case of personal health insurance you get to select the coverage that you want because you are the only one participating and you know just how much you are willing to spend.

In short, you should carefully look over the policies of both types of insurance plans before choosing the one that is right for you, and you should look over the pros and cons of your particular insurance plan before making a final decision.



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