Employer Insurance vs Marketplace Insurance: Which is Best?

HR discussing employee benefits

Employee benefitsIn 2010, before the introduction of the Affordable Care Act, more than 26,000 people died prematurely as a result of lacking proper insurance and being unable to afford medical care. After the new law has been passed, the government opened a new marketplace portal online to help people find a health insurance plan for themselves. This left many people in employment with a dilemma: should they retain or take out a workplace insurance policy or should they choose a marketplace plan? According to HIXME, an expert in employee benefit programs, here are the pros and cons of these two types of policies.

What are the Advantages of Employer Health Insurance?

Partly Funded by Employer – Taking a group workplace insurance plan is an attractive option because the employer pays part of the premium. If their staff member chooses to take out an individual policy, they will not receive this contribution.

Prescription Medicines are Usually Covered – Plans on the government portal do include many prescription medications, but a deductible is usually required before the patient can access them.

For instance, silver plans are the most commonly purchased policy. This plan requires deductibles in 52% of cases. On the other hand, employer-based insurance required it for 11% of policyholders. The average contribution an individual is expected to pay for prescriptions is $13 per generic drug and $44 per brand-name drug. In this case, it is evident that choosing work-based health insurance is more cost-effective.

Out of Pocket Limits – Work-based coverage has smaller out of pocket limits. This is the amount a patient has to pay in any given year for services included in their policy.

Advantages of Marketplace Policies

Cost Assistance – Marketplace health insurance plans for the unemployed or low waged offer either a reduction in premium or a lowered out of pocket limit.

Choice of Doctors – If it happens that the employee’s trusted primary care physician is not covered under a work-based plan, the marketplace offers consumers the chance to shop around.

Accesses to Specialty Drugs – Not all medications are covered under work-based plans, mainly if the patient requires specialty drugs.

Although employer health insurance can be cheaper and have fewer co-pays, marketplace insurance is an excellent choice for people with low wages as it offers cost assistance and greater selection.


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