Group vs Individual/Family Health Insurance in Georgia

Many people face the decision of which type of insurance to use, either group or individual. This decision is especially important to groups that have under 50 employees (small groups). Small groups in Georgia do not have to offer group health insurance. It is only when a group reaches 50+ full time equivalent employees that they must offer group health insurance.

So, for groups under 50, what is the main difference between group health insurance and individual/family coverage? We will discuss each one and then highlight the differences:

Individual and Family Health Insurance in Georgia: The Bad

The landscape for Individual and Family coverage in Georgia has changed drastically in the years since Obamacare became law. The biggest change, outside of the price, has been the multiple companies that used to offer individual and family insurance in Georgia that no longer do. Companies like Humana, UHC, Aetna and Cigna now only offer group health insurance plans.

This is one of the main problems with individual health insurance in Georgia, the lack of choices. Currently the state only has 4 options to choose from and the vast majority of the state has three or less options. Anthem, AmBetter, Kaiser and Alliant are the only individual health insurance options in Georgia for 2019. If someone tells you otherwise they are not being honest with you. Alliant is only in North Georgia and is also the only carrier that offers a PPO. Most of the state have very few options and can only get access to HMO plans. Switching to an HMO means you may have to change doctors to an in-network provider and get referrals from your PCP for additional services.

Individual and Family coverage is also very expensive and is ramping up every year. If you make to much money to get a subsidy, individual coverage will cost you a lot. A family of 4 could end up paying $1500+ a month and still have deductible of several thousand dollars.

The high cost and confusion brought about by Obamacare has also facilitated the rise of predatory practices by some insurance agent and companies. We get calls constantly from people who were sold some type of coverage that was called “major medical insurance” but is in fact some type of indemnity plan. We recommend that you not buy insurance from spam calling companies, companies with no reviews and companies that are not local to your state. Read here for more information on how to avoid scams: 

Individual and Family Health Insurance in Georgia: The Good

The best thing about individual coverage is undoubtedly the subsidy. In 2020, you can qualify for a subsidy if you are a single household that makes under $49,960 or a family of four household that makes under $103,000 a year. You must also meet minimum income requirements in order to qualify. These subsidies can greatly reduce cost for those who are able to get them. Additionally, some of the individual, HMO carriers in Georgia are improving their networks, namely Ambetter and Kaiser.

Unfortunately, the income limitations mean that a large chunk of people are left without getting help from a subsidy. For these people, group health insurance usually makes more sense if they can qualify for it.

Group Health Insurance in Georgia: The Bad

Group health insurance in Georgia has also undergone changes. The main negative change has been steadily increasing prices. Fully insured group health insurance is very expensive. The cost is split between the employer and the employee, but it can still be more than many can afford.

The other downside of a group plan is if a company offers group health insurance, any eligible employees can no longer get a subsidy on the individual marketplace.

Group Health Insurance in Georgia: The Good

Unlike individual and family insurance, group health insurance plans have many more options. There are more companies to choose from such as Humana, BCBS, Kaiser, Cigna, Aetna, UHC and National General, just to name a few. There are also more network choices available with group plans. Companies can choose between HMO or broad, nationwide PPO or NPOS networks.

High cost is driving innovation, and we are seeing more plan options every year when it comes to group health insurance. In addition to the standard, fully insured plans, companies have the option of self-funded health insurance. This is a great option to pursue as it can lead to savings of 20-40% over traditional plans. You can read more about self-funded plans here.

Group Health Insurance in Georgia is not hard to qualify for. Many companies only require two employees to start a plan. And while some companies require strict participation numbers from employees, the large number of carrier options mean that it is usually possible to find a company that will work with how most employers are set up.

Lastly, group health insurance can offer tax incentives for companies that individual coverage does not.

Should I Choose Individual or Group Health Insurance?

If you are wondering which coverage to choose, you are in the right place! Here at Georgia Health Insurance we have both an individual and Family branch as well as a branch dedicated exclusively to Group Health Insurance. We can help you look at both options and pick the best one!

If you are a small business owner who is trying to decide if you should start a group plan for your company, give us a call and we will help you look at all the options. You will always get honest, expert advice when you talk to an agent at Georgia Health Insurance. We are constantly looking at way in which we can help our groups save money and provide great healthcare to their employees.

Call Today! 770-452-9335 or Schedule an appointment:

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