Employers Vs. Individual Health Insurance: What Is The Difference?

Insurance can be purchased through private companies or the Marketplace. The Marketplace provides “income-based premium subsidies for low and middle income people.”

Health care insurance in the U.S. is extremely competitive and not always fair. Recently in 2012, The Affordable Care Act passed by Barack Obama set new regulations regarding insurance. According to this Act, employers of 50+ employees must offer health insurance, public health insurance such as Medicare and Medicaid was made affordable for those that qualify, it is illegal for anyone to be denied insurance due to pre-existing conditions, and everyone must have health insurance or they will endure tax penalties. For Medicare and Medicaid, each state has different qualifications regarding eligibility. Private health insurance is not mandatory, but many of those that can afford it prefer it because it will cover more than any government insurance. Private health insurance also offers family plans along with single plans(varying from company to company), which will definitely attract middle to high income families. Health insurance is an absolute essential in the U.S. as it is up to the citizen to obtain one that works for them.

In the United States, access to health care is largely determined by who has financing to receive insurance (Shi & Singh, 2013, p. 197) Financing for health care comes from many different entities. For most Americans who have health insurance through their employment, the employers pay a part of the insurance premium and employees pay the rest (Shi & Singh, 2013, p.

Group Model HMOs are centered around multi-specialty medical groups that focus on the performance of the group as a whole; they tend to be a bit less structured than the Staff Model HMOs. Many Group Model HMOs have ties to hospitals in the areas in which they practice, but are legally independent of those hospitals. New physicians to group practices must sign a Non-Compete Clause to prevent stealing of patients and often face an entry barrier due to the reverence given to senior members of the HMO.

There are three sources of health insurance coverage, private insurance, Medicare and Medicaid. Medicare is the federal government primary health coverage for those over the age of 65; all persons in this age group are eligible for some basic coverage by Medicare. Although some may only be covered for Medicare part A (hospital coverage only) or part B (physician coverage), but most are covered for both. But for those who are not covered by both, again, presents the problem of being underinsured, which causes the problem of not seeking the medical attention when it is needed. Medicaid is the government?s program for those who are poor and those with disabilities. Private insurance is simply for those who could afford it when it is not offered by the

The marketplace is more designed for people to sign up through ObamaCare as oppose to the insurance that have with their employers. It will be more expensive to have the insurance through the employers than through the market place. Overall, both groups of Americans higher and lower income levels will benefit in a way with the new health care. The Affordable healthcare allows people with pre

| Most American receives their health coverage through the private insurance market, usually through their jobs. Many people buy insurance on their own in the individual market. Since coverage from private companies is the largest surge of insurance for Americans it is likely to be a central part of federal and state health reform efforts. Private health coverage is a mechanism for people to protect themselves from the potentially extreme financial costs of medical care if they become severely ill,

For those Americans not covered or find their work coverage too expensive, there is a new way for them to buy insurance on their own called Health Insurance Marketplaces. Some states have named these marketplaces something else. The Health Insurance Marketplace is like a virtual insurance megamall where private insurers compete for American’s business. Americans can pick out how much coverage they want, how much they want to pay for it, from cheaper high deductible plans to more expensive plans. Regardless what plan is chosen, all plans will cover a complete set of services like hospital visits, doctor visits,

It has been stated that one of the largest benefits to the Affordable Care Act (ACA) for those that were already insured, is that they may purchase insurance through a marketplace allowing for continuous coverage, regardless of life experiences such as a change in job. Even those that are young, and may not appreciate health insurance because they have coverage through their parents, will need insurance once of age that isn’t dependent upon an employer as they are more likely to change jobs more often. Those that purchase health insurance through an employer offered group coverage could be made to feel as though they are captive to a job in order to continue to receive the insurance that they are accustomed to. Subsequently, the ACA has made health insurance more affordable for those that earn a lower income, making group plans more expensive for individuals, overall.

Before ObamaCare, families and individuals who were not covered by employers for healthcare had to seek out insurance on their own. This task proved very difficult as insurance providers charged steep prices for coverage. In short, health care coverage was not affordable to a large portion of the population. The law seeks to cover Americans who are between 138% and 400% of the Federal Poverty Level. They can sign up for Health Care via a government run website, which will allow them to choose a plan that best suits their needs. A formula will then decide based on their state how much a plan will cost for them as well as how much of their health care is

Under the new health care reform law over 47 million women will have access to women’s services with no out of pocket costs for preventative and wellness services (Obamacare, 2013). The low-income individuals will have the opportunity of getting health insurance coverage through the state exchange, Medicare, or Medicaid; however some states have opted out of the Medicaid expansion in which some low-income individuals will not be eligible. Seniors and other individuals eligible for Medicare will see expanding benefits and coverage options; however there will be decreases in home health payments and hospital coverage as well. Obamacare will require businesses with over 50 full-time employees to provide affordable health insurance coverage to its employees however small businesses with 25 employees or less will receive federal tax credits to help offset the costs that a small business will face to encourage these businesses to provide health coverage to

In the video “36 Times Obama Said You Could Keep Your Health Care Plan” Obama repeatedly says “if you like your health insurance, you can keep it” (2013) he had many different places where he spoke and many different backgrounds. Some of his backgrounds look as if they were focused groups. Even one of his backgrounds was AARP and another said “Health Care Town Hall Meeting” (2013). The reason why Barack Obama picked some of these places to talk about his health care insurance was not only to reach out to people that would watch the shows but to follow the interim rules. The interim rules are found in the Federal Register (2010) where one sections sates a “require a group health plan and a health insurance issuer offering group or individual

On top of regulation, in order to help this system reach everyone, Obamacare is designed to offer insurance rates based on one’s salary. And in addition to salary based premium rates, Obamacare is offering subsidies, which is cost assistance that “lowers the amount you spend on your monthly premium (via advanced premium tax credits) or reduces your out-of-pocket costs for things like copays, coinsurance, deductibles and out-of-pocket maximum (cost sharing reduction).” (http://obamacarefacts.com/obamacare-subsidies/) Also, small businesses of a minimum 50 employees are now required to offer insurance for their employees, bringing more people closer to the reach of insurance. Those who previously viewed health care coverage as a luxury can now be closer to obtaining affordable coverage. “The Kaiser Family Foundation estimates that 48% of Americans who buy individual insurance today would be eligible for subsidies. They would receive an average of $5,548, which would cover 66% of the price.” (http://money.cnn.com/2013/08/21/news/economy/obamacare-subsidies/) Aside from insurance regulations, Obamacare has initiated additional perks to enhance the health system for everyone’s benefit. One significant adjustment for children up to ages 19 with pre-existing conditions is that health

The major provision of Obamacare is that most U.S. citizens must enroll in a health insurance plan for the entire tax year or face a penalty. Employers with more than 50 employees must offer workers a health insurance plan, and low-cost insurance exchanges have been set up so that employers and people without coverage can compare plans and buy insurance that meets the following levels of coverage:

There is individual mandate so that insurance companies would have a broad pool of customers: a fraction of whom are healthy, and a fraction of whom are sick or would be sick. That would prevent insurance companies from setting high prices to exclude people with a preexisting condition; so the sick would not all queue up for insurance and healthy people not bothering for health insurance until they get sick. When that happens, insurance companies will quickly go out of business.