Most Americans get their health insurance through their employer, or by being the spouse or dependent of someone who gets their health insurance through their employer. This is probably the most "consumer-friendly" kind of insurance you can have, although it is not entirely without its faults.
Some of the basic features of job-based coverage include:
- Guaranteed issue - All employees are accepted for coverage, regardless of their health status.
- Guaranteed renewability - Your health insurance cannot be cancelled if you become sick.
- Limits on Pre-existing Conditions Exclusions - The insurer can exclude coverage for a health condition you had when you enrolled in coverage, but only for 12-18 months, depending on your circumstances.
- Portability - If you had insurance before enrolling in your job-based coverage, in most cases, the insurer must reduce the pre-existing condition exclusion period by the amount of time you were covered on your previous plan.
- COBRA continuation coverage - When you leave your job (or have another qualifying event), you must be offered COBRA continuation coverage, which lasts for 18-36 months, depending on your situation.
Because job-based coverage is job-based, you are limited to the plan options your employer gives you. This means that you could end up on a plan which limits which doctors you can see, or provides skimpy prescription drug coverage. Your copays and deductibles under your employer's plan could be higher than what you can afford to pay.
However, job-based coverage is almost always your best health insurance option. Federal statutes governing employee benefits protect the consumer, even after coverage is terminated. These consumer protection laws do not apply to individual policies, which are regulated by each individual state. Indeed, if you compare the benefits of job-based coverage with those of individual policies, you will see that job-based coverage does the better job of ensuring patient access to affordable and adequate coverage.
Your employer may offer you different job-based plan options, which means that you will have choose which one will be the best for you or your family. My article HMO vs. PPO describes some popular job-based plan options, and offers helpful advice on how to choose which best suits your needs.
