Ancillary Products: Protecting the Gaps in Your Medicare Coverage
Ancillary products are additional insurance plans designed to fill the gaps that Medicare doesn’t cover. They don’t replace Medicare—they complement it.
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For entrepreneurs, crafting a robust benefits package, including reliable health insurance, is a crucial step in fostering a thriving workforce. However, navigating the intricate landscape of health insurance options can be daunting. This begs the question: What distinguishes group insurance from individual insurance when considering coverage for your employees? Let's delve into their disparities.
March 26, 2025
Group Insurance
Group insurance refers to a health insurance plan provided by employers to their employees and their dependents. This coverage is selected by the employer, who then offers it for purchase by their staff. The premium cost associated with group insurance is divided into monthly payments, which are shared among participating employees. A significant advantage of group insurance is that as more employees enroll, the premium costs per individual decrease.
According to federal law, any business with at least two full-time employees can access group health insurance coverage. This includes single-employee businesses, as business owners are considered employees. The Affordable Care Act (ACA) defines small businesses as those with 2 to 50 full-time employees, although some states classify sole proprietors as a group of one, making them eligible for coverage under a small group policy.
Employers opting for group health insurance must extend coverage to all full- and part-time employees. Notably, individuals with pre-existing health conditions cannot be denied coverage, and their inclusion in the group plan does not affect the eligibility of other employees. Additionally, dependents of eligible employees are entitled to coverage if the employee enrolls in the group plan.
Individual Insurance
Individual insurance involves policies acquired independently by individuals, often through an insurance broker or the health insurance marketplace. These policies operate similarly to group insurance, encompassing features like deductibles, co-pays, and coverage. However, individual insurance tends to come with higher costs compared to group plans.
Employees may choose to inform their employer about their individual insurance actions. Additionally, employees can take advantage of premium reimbursement and tax benefits by obtaining coverage through the health insurance marketplace. Employers can offer an Individual Coverage Health Reimbursement Arrangement (ICHRA) to reimburse employees for premium payments, which can be deducted from the employer’s business taxes.
One drawback of individual insurance is the limited coverage options. Enrollment in an Obamacare plan typically requires waiting for the annual Open Enrollment Period. Conversely, there is no fixed enrollment period for group health insurance, allowing small businesses to secure coverage at any time throughout the year.
Comparing Group and Individual Insurance
Who Purchases the Insurance?
Group insurance is secured by the employer, while individual insurance is acquired independently by the employee.
What Is the Cost Difference?
Individual insurance is generally more expensive due to the smaller coverage pool.
Start Date of Coverage
Coverage for group insurance usually begins within one to two months after enrollment, while individual insurance may have a fixed enrollment period.
Add-On Options
Group insurance may offer add-ons known as riders, depending on the provider. Individual insurance may or may not provide riders.
Are Premiums Tax-Deductible?
Premiums can be tax-deductible for employers offering group insurance and utilizing an ICHRA for reimbursement.
Need assistance? Reach out to Agents Impact at (503) 668-6100. Our support comes at no expense to you.
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