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Wetzel Insurance Agency Blog

All You Ever Wanted to Know About Insurance

When to Opt Out

Opting out of a health insurance plan that your employer offers is not uncommon for employees. Some people want to see a doctor that isn’t offered through the employer’s network or they can get better coverage from their spouse’s network. You can choose to leave your employer-sponsored group plan in favor of the individual health insurance market.


There are things you should know before you decide to dump your employer’s health insurance plan.


1)    There is only certain times that can enroll for an individual health plan. Open Enrollment is usually the only time that you can enroll, and it only lasts for a short period of time. It includes plans in the state health insurance marketplace. There may be a special time where you can enroll outside of open enrollment like if you experience certain life events. Things like moving to a new state, getting married, losing your group health coverage, getting divorced, or having a baby may let you qualify for special enrollment.

2)    You should always shop around for prices before you make the decision to drop your group rate. If your employer subsidizes your health care premiums like most do, you could be able to get better premiums if you are buying your own plan. It won’t necessarily be better, but it’s possible.

3)    You might actually save money by keeping your group plan. You may be able to pay your share of the employer-sponsored plan premiums with pre-tax dollars. You won’t be able to do this if you purchase a health plan on your own.


While there are benefits that come along with using group health insurance, there are also times when you might want out of your employer’s health insurance plan. Here are just a few scenarios where you might want to opt out:


Your employer might offer you health insurance coverage, but it might not contribute to the premiums. Most employers help pay for your premiums, but not all of them do. The amount that they subsidize can vary from employer to employer. You might find a better deal at the marketplace if your employer doesn’t help you pay for your premiums.


Your employer offers you coverage with a lousy plan. The Affordable Care Act has made it so that employer-sponsored plans have to cover at least sixty percent of medical expenses for a “standard population”. You then pay that other forty percent through deductible and co-payments. Your boss could also offer you a plan that might be too expensive for you to pay, and you might be able to get a cheaper one on your own.


Always compare prices when choosing a plan on your own. Look carefully on what benefits each plan offers and whether the health care providers and hospitals you will want to use are part of it. Don’t make your decision solely on the price of each. Factor in all the benefits to find the right deal.