There is simply a staggering range in the quality, affordability, and structure of medical plans. Since I'm a consumer and an insurance broker, I see this from a wide perspective. Here's what I see:
- All group plans are not created equal
I've had customers who were desperate to get on a group plan, I've had customers who were on a group and wanted out because they felt they were paying too much or felt that the benefits were inadequate, and I've had customers who loved their group coverage, but wanted indivual coverage for a family member because it cost more to add them under the group than it did to cover them individually. Moral of the story; It just depends. My wife works for the county hospital and has great benefits, but I cover myself and my daughter on an individual basis because it is cheaper than to add us as dependents under her group plan. The other wildcard of group coverage how much of the monthly premium the employer picks up. I know people who's group plan pays 100% of their premium, I know others who pay half of their monthly premium.
- Individual Plans and the pre-existing condition
This is the issue that can really make it hard on people who, for whatever reason, are not eligible for group coverage. In general, individual plans won't cover pre-existing conditions such as asthma, ulcers, chronic joint problems, etc. In some cases, the individual can get the coverage, but will be excluded for any benefits covering that specific condition. Moral of the story; individual plans are great if you are healthy to begin with.
- HSA plans
Essentially, an HSA plan is an individual plan minus the co-pay benefit for doctors visits and prescriptions, plus a health savings account with tax benefits and potential investment options. Again, on the individual basis, this works better if you are healthy to begin with. The HSA can allow you to accrue a discretionary lump sum to direct pay for a wide array of medical costs including dental and vision fees. Moral of the story: did you or did you not contribute enough to the HSA to pay your exposure for office visits and prescriptions? Personally, I like the HSA because of the tax benefits and the potential for investment----IF YOU ARE LUCKY ENOUGH TO STAY SAFE AND HEALTHY ENOUGH NOT TO HAVE TO USE THOSE FUNDS.
- Catastophic Plans
In general terms, the catastophic plan is an accident indemnity policy with various optional riders that can be attached to it. Some examples of the riders can be: $400/day payout for every day you are in the hospital, $1,000 lump sum for being admitted to the hospital, $40,000 lump sum for critical illness(cancer, heart attack, stroke). Different carriers will have various additional rider choices, but that's it in a nutshell. There are no benefits for doctors office copays and prescription copays. Usually. There are some of these plans that will offer an discount card in lieu of copays. Moral of the story; this is limited coverage with huge gaps, but given the right situation, it can save you a bundle.
Many of my customers will take the comprehensive indiviual medical plan and the catastophic plan together. The catastophic benefits are non-coordinating, meaning they pay direct to the insured regardless of other insurance in force.