Employer-Sponsored Health Coverage

The Basics

Health coverage helps pay for medical costs. A health care plan has a set of services that the plan provider agrees to pay for if you need them, like when you see a doctor or go to the pharmacy.

One way to get health coverage is through government programs like Medicare or Medicaid. Another way is to get private health coverage, either by buying an individual plan on your own or by getting coverage through your job, your parent’s job, or your spouse’s job, which is called employer-sponsored group health coverage. Getting coverage through your job or through a family member’s job is the most common way people get health coverage in the United States.

This article is about getting health coverage through an employer. It will help you understand:

  • If employer-sponsored coverage is right for you
  • What services your plan will cover
  • How to choose a plan
  • How much you will have to pay for health care, and
  • How to sign up.

If you need more help in understanding employer-sponsored coverage after reading this article, we recommend you talk to trained experts. Here are some good resources:

  • An employer’s Human Resources department will know about the specifics of the health coverage options it offers.
  • If you have questions about how your disability affects your health coverage, talk to a benefits expert.
Highlights
  • All employer-sponsored plans should meet minimum affordability standards. That means the employed individual's monthly premium for their own health coverage should be 9.02% or less of their household income.
  • All employer-sponsored plans should meet a certain benefits level.
  • If your household income is at or under 100% of the Federal Poverty Guidelines (FPG) and you have employer-sponsored coverage, the Georgia Pathways to Coverage Medicaid program may either pay your employer-sponsored coverage costs (like your premiums and copayments) or provide you with Medicaid coverage through a managed care plan.

Note: DB101 keeps track of changes to health coverage and related laws. DB101 has been and will continue to be updated to reflect any changes. Visit KFF for news related to health coverage.

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