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How is health insurance through your employer different from Marketplace health insurance?


How is health insurance through your employer different from Marketplace health insurance?

As the name suggests, Individual & Family Health Insurance is for individuals and their families while Group Health Insurance refers to the health insurance that is offered by an employer to their employees. In many ways they are going to appear the same when you use them, but there are several differences that are valuable to note. One of the biggest differences is their networks.

If you don’t know already, networks are a group of doctors and hospitals that accept the insurance from a certain insurance carrier. Blue Cross Blue Shield will have a different Network than United Healthcare. Read more on Networks here.

Aside from networks being different from one insurance carrier to another, these networks come in several different types, each with their own advantages and disadvantages. It’s important to keep in mind that each state will have different availability on some of these types of networks. The most common networks you are likely to encounter are called HMO, EPO and PPO networks. HMOs are the most common around the country, but in Tennessee, the only networks available on the Marketplace ( are EPO networks. As for PPO networks, these are typically only available on major medical plans through group health insurance. If you’ve only had insurance through your work or only through the marketplace, you might be interested in their differences.

Simply put, your work insurance will likely, but not always, cost a little more than marketplace insurance in exchange for greater access to doctors and other healthcare providers. By law, your employer must pay half the costs of your health insurance premium if you are on their group plan. They may also choose to pay the majority or all of your health insurance costs as a benefit of working at their company. This could end up being the more affordable option depending on how much your premiums would be if you received your insurance elsewhere.

Marketplace insurance has smaller networks, typically HMO or EPO. Although these networks are more restrictive than PPOs, most of the time this is not a problem because you can choose between the networks of the different carriers and find one that has the doctors and hospitals you need. Because of the smaller HMO and EPO networks, the cost of the insurance plan that uses these networks will be more affordable than a PPO network. In addition, many applicants applying for marketplace insurance will receive a subsidy, the amount will depend on what you qualify for. You can qualify for a subsidy that covers anywhere from 1% to 100% of your monthly premium. It should be noted, however, that in some cases you will not be eligible for a subsidy if you are over or under a certain income bracket or are offered insurance through your job. If you are interested in how much of a subsidy you qualify for, feel free to schedule a time with Josiah and he can run some quotes for you!

If the only insurance you’ve ever had is from your work, and you are curious about what the marketplace has to offer, just know that it is high quality, will never stop paying for covered services, will provide preventive care for free, and will only cover medical needs if you seek care that is inside the network (unless in an emergency situation. More on that here). Make sure you choose a local, trustworthy agent though as there are lots of massive call centers out there trying to sell junk insurance products (read more HERE).

I’ve only briefly talked about HMOs, EPOs and PPOs, but if you would like to know more about networks, you can read our blog about Networks here!

Need help with an individual or family health insurance plan? Call us today! 615-528-1227


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