For individuals without access to employer-sponsored health insurance, there are still several ways to obtain group health coverage.
One common route is through professional or trade associations.
Many organizations offer group health insurance as a benefit to their members, leveraging the collective buying power of the group to secure better rates. Examples include industry-specific associations, alumni organizations, and groups like AARP, which caters to retirees.
Joining these associations often requires a membership fee, but the access to group health plans can make it worthwhile.
Some criteria that determines whether an organization is eligible or not:
- The organization must have a primary purpose other than providing health insurance. (For example, the group should focus on providing educational resources or fostering a network for industry professionals.)
- Insurers may impose minimum membership requirements for the organization to qualify for group coverage.
- The organization must be willing to sponsor the health plan, which involves negotiating with insurers, administering the plan, and ensuring compliance with applicable laws. This role requires administrative capacity and resources.
- All qualifying members must have access to the plan under the same terms, regardless of factors like age, gender, or health status.
Another option is health insurance cooperatives (AKA insurance co-ops)
Health co-ops are nonprofit entities formed to provide health insurance coverage. Unlike traditional insurance companies that operate for profit, co-ops prioritize the needs of their members. The goal is to provide affordable and accessible healthcare options through collective participation.
Co-ops typically function under a membership model, where individuals or businesses join the cooperative, contributing premiums to a shared pool of funds. These funds are then used to pay for members’ medical expenses and administrative costs.
In this situation everyone in the co-op would have the same coverage regardless of age, health, income, or preferred providers.
Small business group health insurance:
If you’re a small business owner looking for group health insurance rates, you may qualify once you employ others. By hiring at least one full-time employee who is not a spouse, you may qualify as a small business and gain access to group health plans.
These plans can be purchased through private insurers or programs like the Small Business Health Options Program (SHOP) Marketplace.
Not only can this approach provide lower rates than individual plans, but it may also offer tax advantages for the business.
Health care sharing ministries:
These are non-insurance organizations where members contribute to a shared fund used to cover one another’s medical expenses. While often more affordable than traditional insurance, they come with limitations, such as exclusions for pre-existing conditions and no legal guarantees of payment.
In some states, there are also government-sponsored programs that provide group-like plans for individuals. These programs, designed for sole proprietors or small businesses, aim to fill gaps in the insurance market.
Their availability and specifics depend on the state.