Employer-Based Insurance

Many individuals receive health insurance coverage through a job or place of employment. This employer-based insurance coverage can either be from your place of employment or that of a family member (spouse, parent, etc.) Frequently, the employer or company will pay a portion or sometimes all of your health insurance premium. You are responsible to pay the portion of your health insurance premium not covered by your employer in order to keep your insurance active. The insurance premium payment can sometimes be deducted directly from your paycheck, or you may need to pay the outstanding balance to your human resources (HR) office or to the insurance company directly.

An employer will offer a limited number of insurance policies or plans to select. Sometimes there may only be one option for health insurance offered at a place of employment. Limited policy selection can take some of the guesswork out of choosing a health insurance policy; however, if you receive employer-based insurance coverage, MSAA’s Healthcare Insurance Glossary may be of assistance in understanding how your insurance policy works.

What if I want to consider other options?

If you purchase or receive employer-based insurance coverage but are not happy with your options for insurance, you may be able to enter the Health Insurance Marketplace to select an alternate policy. Please note that if your employer contributes to your premium payments and you purchase a policy through the Marketplace, your employer will no longer contribute to your premium payment. Please also note that you may not qualify for cost savings on Marketplace policies unless your available employer policy does not meet very specific criteria – such as minimum value standards of the premium for an employee plan (not family plan) costing more than 9.5 percent of your annual salary. To learn more about employer-based insurance versus the Marketplace, please visit: https://www.healthcare.gov/what-if-i-have-job-based-health-insurance/

You may also be able to purchase a private insurance policy. Please see “Purchasing Private Health Insurance” below to learn more.

What if I (or my family member) leave the job?

When you leave a job and have employer-based insurance, you may be able to carry over your same insurance policy for a specific time period (through COBRA). Typically, you will pay the full premium for your health insurance policy, including whatever portion your employer previously paid. Another option is to enter the Health Insurance Marketplace to shop for a new health insurance policy. You can learn more about COBRA by visiting: https://www.healthcare.gov/what-if-i-currently-have-cobra-coverage/

Purchasing Private Health Insurance

You can purchase private insurance policies in a variety of different ways, including the Health Insurance Marketplace. Many individuals purchasing health insurance through the Marketplace may qualify to receive help for paying insurance premiums, co-pays, and co-insurances.

Another option is to contact health insurance companies directly to see what plans are available in your area. You can also contact a health insurance agent who typically explains available health insurance plans offered by one health insurance company, or contact a health insurance broker who typically offers information on an array of available plans from different health insurance companies. You can also find online resources for purchasing health insurance.

For assistance locating health insurance companies, agents, or brokers, you can search for your local Department of Insurance on the National Association of State Insurance Commissioners site: http://www.naic.org/state_web_map.htm.