When buying health insurance in Florida, you can either pay for just yourself or buy a plan that also covers your family. Qualifying household members include your spouse, children, foster children, grandchildren, an adult child with disabilities, and legal dependents. The cost of coverage increases when you want to insure more people, which is why finding the best policy for your needs is so important.
Our team of dedicated brokers work hard to help every client find the right coverage for them. Whether it’s a low-deductible health insurance policy for a single person or family coverage for children with special needs, we want you to get the coverage you deserve to have peace of mind.
Read on to learn more about the difference between individual vs family health insurance, including costs, deductible, copays, and more.
What Is Individual Health Insurance?
When you buy health insurance for yourself, this is called individual health insurance. Each policy covers one person, called the policyholder. When it comes to individual health insurance, you may buy a policy on your own, or your employer may offer coverage as part of a group health insurance plan.
This article will focus on personal health insurance you can buy during the Open Enrollment Period or after a Qualifying Life Event.
Coverage Options
You aren’t limited when it comes to health insurance options. Individual plans come in a wide range of networks, which are groups of doctors and specialists that treat different health conditions. Certain plans are best suited for people with chronic conditions or those who require specialized care; other types of health insurance can lower your deductible — the total amount you have to pay before your provider covers your medical bills.
Let’s look more closely at the types of health insurance available.
HMOs (Health Maintenance Organizations)
An HMO is the simplest form of health coverage. These plans tend to have the lowest out-of-pocket costs and deductibles. In order to receive care, you have to visit a doctor who is in your provider’s HMO network. Generally, HMOs will not cover any out-of-network costs, even if you’ve met your deductible, unless there is an emergency.
PPOs (Preferred Provider Organizations)
PPOs allow you to choose your own doctors and specialists, so long as they accept your health insurance. You do not need a referral from your primary care physician to see a specialist. Many people enjoy the freedom PPOs provide, especially when they want to explore different providers before choosing their doctors.
POS Plans
A point-of-service (POS) plan is like a combination of POS and HMO service. You can visit point-of-service providers in-network or out-of-network, but you will pay more for seeing providers that fall outside your providers network. Usually, you have to work with a primary care physician in a POS plan to receive referrals for specialists.
HDHPs (High-Deductible Health Plans)
For those who do not have chronic conditions or underlying health problems, a high-deductible health plan offers lower costs and more affordable monthly premiums. These deductibles are high because policyholders want to keep maintenance costs low. The 2024 minimum annual deductible is $1,600 for self-only HDHP coverage (up from $1,500 in 2023) and $3,200 for family HDHP coverage (up from $3,000 in 2023). However, there are HDHPs that have much higher deductibles and, consequently, lower premiums.
What Is Family Health Insurance?
Family health insurance offers coverage for individuals and their qualifying family members, such as spouses, children, and adult dependents with disabilities. When it comes to family health coverage, you have to meet an individual deductible for each person’s care. These deductibles can count toward your family deductible, but it depends on the type of plan. It’s important to carefully explore a policy’s terms and structure before committing to coverage, especially if your loved ones need routine care.
Coverage Options
There are several options when it comes to family health insurance. You can buy a policy on the healthcare marketplace during the open enrollment period, or you can use employer-based coverage. There is also private insurance, which you can buy directly through a provider on your own or with the help of a health insurance broker.
Healthcare Marketplace
Family plans on the healthcare marketplace are sponsored through the federal government. They are ranked by different metal levels ranging from bronze to platinum, and coverage varies drastically. You can only buy marketplace insurance during the open enrollment or special enrollment periods triggered by life events, such as having a baby, moving to a new state, or changing employers.
Employer-Based Insurance
Employer-based insurance, also called employer-sponsored health insurance, tends to offer lower monthly premiums. Your employer will pay for a portion of your premium. In some cases, employers offer to pay all of a person’s health insurance, but they will likely charge for additional family members. These types of plans are available from many providers, though most companies tend to only offer coverage from one or two.
Private Insurance
Private insurance is one you seek out on your own. These family health insurance plans are not backed by the government. You get to choose the provider, plan type, and type of policy based on your budget and needs. You have the most flexibility with private insurance, and you may be able to buy a policy year-round.
Benefits and Drawbacks
There are some pros and cons when it comes to individual vs family health insurance. Let’s look at each one to give you a better understanding of your options.
Pros and Cons of Individual Health Insurance
The main advantages of individual health care are the lower costs and flexibility when it comes to choosing your provider and the type of structure your health plan follows. Whether you want an HMO, PPO, POS, or HDHP, you have plenty of options as an individual.
Drawbacks of individual health coverage include high deductibles and out-of-pocket expenses, as well as no coverage for your family members. This means that without their own coverage, your spouse, children, and other qualifying household members would need to pay for their own medical expenses.
Pros and Cons of Family Health Insurance
Family coverage is a great way to protect your loved ones, but it does cost more per month to maintain. If you have a tight budget, affording healthcare for your loved ones may be a significant financial burden. However, there are varying options available that can provide at least basic coverage and lower costs for regular medical care.
Private family plans tend to be more expensive than employer-based options. If you are struggling to afford coverage, you may look into state subsidies like Medicaid and CHIP for children.
Choosing Between an Individual and Family Plan
Before you decide on the right level of coverage for your household, here are some options to consider. In some cases, buying individual coverage for each member can actually be cheaper than a family plan. Before you decide on a plan, keep these points in mind.
Family Size and Structure
The size of your family will greatly influence how much it costs to maintain coverage. The more people on a policy, the higher the monthly premium. Structure also plays a factor; children rely on their parents to provide them with healthcare. You may buy child-only health insurance, and in some cases, it is free through state programs and subsidies.
Health Needs and History
When it comes to health insurance, you need a policy that can support all your needs. Health is ever-changing, and it’s important to have peace of mind. You need coverage for both routine care and any conditions you have or are at risk of developing. Consider your unique needs, and be aware that certain pre-existing conditions may result in higher costs.
Budget Considerations
It is important to consider premium differences and out-of-pocket expenses when deciding between individual and family health insurance. A broker can help you weigh your options and strike the right balance between cost and coverage for your needs.
Making the Decision
When it comes to deciding between family vs individual health insurance, we suggest carefully exploring your options to decide where you get the most return on investment. Consider reaching out to a Florida health insurance broker at Live Health Insurance today. We have over 100 years of combined experience matching clients with personalized health coverage for their needs.
Learn more about our health insurance plans, and contact us today to speak with an experienced broker.
