Group Coverage is health insurance provided to employees by an employer or by an association to its members.

Individual Coverage is health insurance you buy on your own, not related to your employer or an association.

What is the difference?

If you have had or currently have group coverage, then you know how that works. Your employer typically gives you a choice of a few different health insurance plans, pays for some or all of your monthly premium, and automatically deducts your premium from your paycheck. They also provide you with any documentation for your plan and can help answer questions about your plan.

For many, this is how they get their health insurance. But what if you are self-employed? What if your in between jobs or you just graduated and don’t yet have a job? For those who cannot obtain group coverage or would like to seek alternative options to their group coverage, individual coverage is an option.

With individual coverage, you will shop for and choose a plan that covers you and/or your family. Your state’s marketplace would have many options that you could choose from. You purchase your plan, make your monthly premium payments, and get to manage your own benefits.

Both types of coverage are customizable based on your needs, family size, and budget. They also cover a variety of areas including dental insurance, vision insurance, disability insurance, and life insurance.

How do you get individual coverage?

The Affordable Care Act (ACA) states that individuals can no longer purchase health insurance at any time. You must purchase individual coverage during the open enrollment period, which since 2018 has been November 1 through December 15th. Recently, this enrollment period has been extended due to COVID-19.

Individuals who miss this open enrollment period can qualify for special enrollment if they experience one or more of the following life events:

  • Getting married
  • Getting divorced
  • Having a baby, adopting a child, placing a child up for adoption or foster care
  • Moving
  • Becoming a U.S. citizen
  • Leaving incarceration
  • Loosing other health coverage due to job loss, divorce, COBRA expiration, or aging off a parent’s plan
  • Losing eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)
  • A change in income or household status that affects eligibility for premium tax credits or cost sharing reductions.
  • Gaining status as a member of a Native American tribe

When it comes to your coverage choices, you have options. Every situation is unique and there are plans to fit each circumstance. Our licensed agents have the expertise to connect you with the right plan for your needs and budget. If you do not have access to group coverage or are looking into individual benefits, give us a call at 844-GANNONS to discuss your options.