My Employer Health Insurance Is Too Expensive. What Are My Options?
If your health insurance through work is getting more expensive every year, you're not stuck with your employer's plan just because it's offered to you.
For some people, employer coverage is a great deal. Your employer may pay a large portion of the premium, making it hard to beat.
But that's not always the case.
If you're paying a large amount for coverage through work, especially if you're relatively healthy, it can be worth comparing what else is available.
Why Is Health Insurance Through My Job So Expensive?
Employer health insurance can get expensive for several reasons.
Your employer may cover part of your premium, but you still have to pay your portion through payroll deductions. Family coverage can be particularly expensive when you're adding a spouse and children.
You may also be paying for a plan with benefits you don't use very often.
If you rarely see a doctor, don't take expensive prescriptions, and generally don't use much healthcare, you may start wondering why you're paying so much every month.
That's when it makes sense to compare your alternatives.
Can I Get Health Insurance Outside of My Employer?
Yes. Having access to health insurance through work doesn't necessarily mean you have to use that plan.
Depending on your situation, you may be able to purchase individual health insurance through the ACA Marketplace or look at private health insurance options.
The important part is figuring out what you're eligible for and comparing the actual costs.
What About ACA Subsidies?
This is where things can get a little more complicated.
Having an offer of employer-sponsored coverage can affect whether you qualify for financial assistance through the ACA Marketplace. The rules depend on factors such as the cost of the employer coverage and whether it meets the required standards.
So if you're offered coverage through work, don't automatically assume you'll be able to get a large ACA subsidy if you turn it down.
For some people, that makes private health insurance especially worth looking into.
Is Private Health Insurance a Good Option If I'm Healthy?
For someone who is relatively healthy, private health insurance can be one of the first alternatives worth comparing.
Some private health plans use medical underwriting, which means your health history can be considered when determining eligibility.
If you qualify, the premium may be significantly lower than what you're currently paying through your employer or what you would pay for an unsubsidized ACA plan.
This can be particularly interesting if you:
- Rarely go to the doctor
- Don't have expensive prescriptions
- Are generally healthy
- Are paying a large employer premium
- Don't qualify for significant ACA financial assistance
- Want to lower your monthly insurance cost
Private plans aren't the right fit for everyone, but if you're healthy and paying a lot for coverage, it's absolutely worth seeing what you may qualify for.
What If I'm Covering My Family?
Family coverage is another situation where comparing alternatives can make a big difference.
Your employer may offer reasonably priced coverage for yourself but charge substantially more to add your spouse or children.
If the cost of family coverage is eating up a large part of your paycheck, it may be worth comparing individual and private options for your household.
You may find that there are more affordable ways to structure your family's coverage than simply adding everyone to your employer plan.
What Should I Compare?
Don't look at the monthly premium alone.
When comparing your employer plan with other options, look at:
- Monthly premium
- Deductible
- Out-of-pocket maximum
- Doctor and hospital networks
- Prescription coverage
- Copays and coinsurance
- What services are covered
- Any eligibility requirements
The goal isn't necessarily to find the cheapest insurance possible.
It's to find the coverage that makes the most sense for what you're paying.
You May Have More Options Than You Think
If your employer health insurance is expensive, you don't have to automatically accept the price.
ACA coverage may be an option. Private health insurance may be an option. And depending on your situation, one may make significantly more sense than the other.
That's what I help with at Kato Healthcare Options.
I'll look at your age, location, household, health history, current coverage, and what you're trying to accomplish, then compare the options available to you.
If your employer health insurance is costing you too much, let's see what else you may qualify for.
