Health insurance coverage and associated costs vary greatly based on whether the insurance is an individual policy (for the self-employed/unemployed), for a small businesses (from 2 to 50 employees), or for a large group. Coverage for group plans is far more comprehensive and considerably less expensive because there are more people paying into the insurance pool making more money available group-wide to cover medical claims.
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Those who try to get health insurance on their own, either because their employer does not offer this benefit or because they are self-employed or unemployed often have difficulty obtaining health insurance. Many simply cannot find an insurance company in their state that is willing to offer individual plans. Pre-existing conditions complicate this search and put individuals into a ‘high-risk’ category. It’s often the reason coverage is denied.
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Those who are fortunate enough to find individual coverage don’t feel so fortunate once they review the policy details. They typically find that the cost is significant and the coverage less than desirable and loaded with out-of-pocket costs. Those who obtain health insurance on their own can usually purchase a family plan, but then the costs are even higher.
Those individuals who are employed by small businesses, defined as having more than 2 but 50 or fewer employees, also find themselves in a difficult situation when it comes to health insurance. If the employer chooses to, it may offer a group type of health insurance to the employees. When applying for coverage, the overall costs will be based on the number and physical condition of all the employees who wish to participate. High risk individuals and those with pre-existing conditions will bump up the costs for everybody. Even so, the costs for this type of coverage will usually be better than if each employee obtained an individual policy. Employers are not required to cover other family members and can choose the percentage of the employee’s costs that they will cover.
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Group health insurance generally offers the best coverage at the most affordable price. Group insurance is available to all eligible employees of the company offering the health insurance and generally also to the employee’s immediate family members, including spouse and/or children. A group plan must accept every eligible employee even if the person has a known pre-existing condition and even if that person or his/her family members fall into a high-risk category.
Whether you need private health insurance if you participate in a group health plan is not an easy question to answer. To adequately assess this situation, you’ve got to review your group insurance coverage and compare it to what you need. Some group health insurance plans exclude certain medical services such as dental and vision care, experimental treatments, cosmetic surgery, some mental and substance abuse therapies, and more so you may find you need to complement your group plan with a private health insurance plan. In doing so, you’ll incur more costs so you’ll have to weight the additional benefits against the additional costs to see what makes sense for you.