Medical coverage through an employer is more than a common perk in America – it’s become the norm.
All companies with 50 or more full-time employees are required to provide health coverage to all full-time employees. And many smaller companies still offer health insurance as an employee benefit to help them stay competitive.
If you’re like over half of Americans, then you’ve got health coverage through your employer.
But not all employer health plans are created equal.
Some employer health plans include dental, vision, or critical illness or accident coverage. But some only offer reduced dental or vision benefits, while others don’t include any coverage beyond basic medical needs.
Beyond high monthly premiums or deductibles, there are a few reasons why shopping outside your employer’s plan might make the most sense for you and your family.
Certain HMO or DHMO plans may keep you from receiving full coverage if you see your favorite doctor or dentist if they’re out of network. And only around 35% of employers offer vision benefits to their employees — which isn’t the best strategy for employers, considering even minor vision problems can reduce your productivity by up to 20%.
Even if you’re covered through your employer, here are the benefits of getting coverage on your own.
High out-of-pocket costs
Out-of-pocket costs like monthly premiums, deductibles, copays and coinsurance can add-up.
If your employer health care plan is too costly, it may make sense to shop outside of your employer plan to find a plan that fits your budget.
When you look for a private health plan outside your employer, you can choose a plan that makes sense with your budget.
You can look for lower-deductible plans with less coverage if that suits your lifestyle. Or you can shop for supplemental insurance coverage like a critical illness plan if expensive health conditions like heart disease run in your family.
If dental or vision coverage isn’t provided by your employer, you can also find these plans through a private provider.
You may be able to save money by bundling your dental or vision benefits with a new health plan outside your employer, or by buying dental or vision separately through a different provider.
Not the right coverage
If you’ve got an active tyke at home whose collisions on the soccer field or epic wipeouts on the ski hill still leave you with hefty out-of-pocket costs, you may need a health plan with more coverage.
Supplemental health plans like accident Insurance through Guardian Direct helps protect you and your family in the case of an accident. And the Organized Sports Benefit adds more cash to your payout in the incident your little athlete has a covered accident while playing an organized sport.
And if you’ve got a family doctor who you can’t live without, but they’re not in your employer-provided HMO or DHMO, a private PPO or DPPO plan that allows you to see any doctor you want may be a better choice.
On the other hand, if you’re a single entrepreneur who’s tired of paying high premiums for coverage you just don’t need, a lower-deductible plan with less coverage may be the right balance for you.
No dental coverage
Employers aren’t legally required to offer employees dental benefits. But many employers still do: about 50% of companies offer dental insurance.
This is a smart incentive, considering dental benefits are reported to be one of the most highly desired employee benefits.
If your employer doesn’t offer dental benefits, you have options for finding a dental plan that fits your budget and coverage needs.
You can either:
- Purchase your own health plan that includes fuller dental coverage, or
- Purchase dental coverage separately from your health plan.
You can shop for health and dental plans on a private exchange, on the state or federal marketplace. When you fill out an application for a state or federal marketplace, you’ll find out if you qualify for:
- A health insurance plan with savings on your monthly premiums and out-of-pocket expenses (based on household size and income).
- Free or low-cost coverage for you and your family through Medicaid or the Children’s Health Insurance Program (CHIP).
No vision coverage
Regular eye exams can help detect more than poor eyesight. Your optometrist can find early signs of diseases like cancer, diabetes, and high blood pressure through your eye-exam.
If vision benefits aren’t included in your employer insurance plan, you can purchase a secondary insurance plan on a state or federal marketplace, or through a private provider.
It can be a relief to have health coverage provided by your employer. But sometimes, you might need to supplement that coverage.