Health insurance: Take it at work or go it alone?

Soon you’ll receive your employer’s open enrollment packet, and if the benefits experts are right, you could be facing a premium increase as high as 20 percent.

If you’re young, healthy and barely use insurance, you might wonder if you are better off leaving your employer plan and finding a less expensive individual policy tailored to your fewer needs.

There’s no simple answer.

“It may be they can get a plan that’s just as good or possibly even better than what their employer offers for less money on the individual market if they are young and healthy,” said Karyn Schwartz, a senior policy analyst with the Henry J. Kaiser Family Foundation.

But there are many individual plans that lack the comprehensive coverage of an employer-based plan, she adds.

“You can end up with a situation where your health care needs aren’t being met by the insurance you bought. It’s hard to figure out, and you don’t have (a human resources) department to help navigate it,” Schwartz said. “If you have any health problems, you can end up with some pretty serious bills.” And you won’t be able to switch back to your employer plan until the next open enrollment.

Benefits of work plans

Make no mistake, you need insurance. Going without insurance to save a buck is not an option.

And there are plenty of good reasons to stick with your work plan. Besides often offering generous benefits, employer plans don’t require that you be in perfect health to be covered. Employers also pick up a good chunk of the cost, which many workers don’t realize.

A Kaiser study found this year that the average annual premium in a workplace plan was $13,375 for family coverage and $4,824 for singles. Yet the employee on average pays $3,515 for family coverage and $779 for single coverage.

At $779 a year, that’s about $65 a month. “For most people, that would be tough to find comprehensive coverage for less than that,” Schwartz said.

Kaiser also found that 81 percent of workers enroll in employer-sponsored plans when offered them. Of those who don’t enroll, the likely reason is they are being priced out, Schwartz said.

Shopping for insurance

For those in such a squeeze, it’s worth investigating whether they can find an affordable policy in the individual market, she said.

One of the advantages of an individual policy is you can select your benefits, Sam Gibbs, senior vice president of eHealthInsurance.com, an online insurance broker, said. “Only pick and choose the benefit you need and save a substantial amount of money.”

A young male, for instance, doesn’t need maternity benefits that are typically included in a workplace plan.

Don’t just choose the cheapest policy, Gibbs says. “Spend extra time and know what you are getting for your money,” he said. Also, look at the maximum out-of-pocket costs you could pay each year under the policy.

According to eHealth, a 25-year-old Baltimore man who doesn’t smoke can find a policy with premiums ranging from $33 to $373.70 a month. But dig into the details. With the cheapest policy, the annual out-of-pocket costs — including the deductible — can be as much as $12,500.

“Try to look carefully at the plan and exactly what it covers. A lot of plans have caps that might be hidden in the fine print,” Schwartz said. A plan may cap, say, outpatient hospital care, which might not seem like a big deal. But given that more and more illnesses, including cancer, are treated on an outpatient basis, a cap could be significant, Schwartz said.

Be warned, you might not qualify for an individual policy if you have certain health conditions. And once you look closely at the numbers, it’s possible that an employer plan may be cheaper after all because of the company’s subsidy.