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Individual vs. Group

Health insurance provided to employees by an employer or by an association to its members is called group coverage. Health insurance you buy on your own—not through an employer or association—is called individual coverage.


Those are the basics. But what does it mean for you if you're changing from group coverage to individual? What will be different for you?


Group vs. Individual coverage

You're probably used to certain things if you've had employer-sponsored coverage. Your employer may:

  • Give you a choice of health insurance plans

  • Pay for all or some of your monthly premium

  • Deduct your share of your premium from your paycheck each pay period

  • Provide your plan documents

  • Answer questions about your plan


If, for some reason, you can't get coverage through your employer anymore, you'll still need a health plan. For many people, that means buying individual health insurance. 


Unlike traditional employer-sponsored insurance, now you'll:

  • Shop for and choose a plan that covers you and your family

  • Purchase your plan

  • Make all monthly premium payments

  • Get to know and manage all of your health coverage and benefits


Depending on how many employees there are, group and individual plans' benefits may differ. All health plans for individuals and businesses with fewer than 50 full-time equivalent employees cover the same ten essential health benefits. But if your employer has 51 or more full-time equivalent employees, they have more say in what your plan does and doesn't cover.

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