Group health insurance is health coverage offered to a group of people — typically employees of a company or members of an organization — under a single policy. Employers are the most common sponsors, though unions, professional associations, and other groups can also offer group plans.
Group coverage typically offers lower premiums than individual plans because risk is spread across a large pool of enrollees, and employers usually contribute a portion of the premium — often 50–80% for the employee, though family coverage contributions vary widely.
Key characteristics of group health insurance:
If you have access to an affordable group plan through your employer, you generally do not qualify for Premium Tax Credits on the Marketplace — even if a Marketplace plan might cost less after subsidies.
Most employers contribute to employee-only coverage, but family coverage contributions vary. Some employers cover 100% of employee premiums but little or nothing toward dependents. The “family glitch” IRS fix (effective 2023) now allows family members to access Marketplace subsidies if the family coverage under the employer plan is unaffordable, even if the employee’s own premium is affordable.
Losing group health insurance involuntarily (job loss, reduction in hours) is a qualifying life event. You have 60 days to enroll in a Marketplace plan or elect COBRA. Voluntarily leaving a job and choosing to drop coverage does not always trigger an SEP — but losing coverage as a result of the separation does.
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