Work plans charge a young, healthy employee the same as everyone else on the plan. If your employer pays most of the bill for you alone, you're probably fine. If a big chunk comes out of your check, or you're paying to add a spouse, a private plan priced on your age and health may cost less. You'd give up your employer's share and the pre-tax deduction, and private plans can turn people down, so compare the real numbers before you switch anything.
You're paying the group price, not your price
An employer health plan is priced for the whole group. The insurer looks at everyone on the plan, young and old, healthy and not, and sets one price. Most employers then split that price the same way for every employee on a tier: everyone with "employee only" coverage pays the same paycheck deduction, and everyone with "employee + spouse" pays the same, and so on.
That's a great deal if you're 58 with a bad knee. If you're 25 and haven't seen a doctor since your last sports physical, you're helping pay for everyone else. Nobody tells you that at orientation. You just see a number on your paystub and assume it's the price of insurance.
Insurance you buy on your own works differently. Price follows age. Under federal rules for individual plans, premiums can be up to 3 times higher for older people than for younger ones (HealthCare.gov). Private medically underwritten plans go a step further and also look at your health. So the younger and healthier you are, the more an individual plan's price tends to work in your favor.
What workers pay on average (and when you're fine)
KFF's 2025 survey of employer plans found the average yearly premium was $9,325 for single coverage and $26,993 for family coverage. Workers paid, on average, $1,440 a year toward single coverage and $6,850 toward family coverage. Employers paid the rest.
Two things jump out:
- For single coverage, many employers pay most of the bill. If your share is close to that average, about $120 a month, your work plan is likely hard to beat. I'll tell you that straight.
- Adding people costs a lot more. The average worker pays nearly five times as much for family coverage as for single. At small firms it's even higher: workers paid an average of $8,889 a year for family coverage, versus $6,227 at large firms.
Averages hide a lot. Some employers pay almost everything. Others, often smaller businesses, pass a big share to employees, and some high-deductible plans come with a deductible a healthy young person would almost never reach. That's where the overpaying usually happens.
Send me the number off your paystub. I'll price it against private options and tell you which wins. Free, and no pitch at the end.
The spouse problem nobody explains at onboarding
This is the one I see most with young couples. Your employer may pay a big part of your own coverage, but contribute much less, or nothing, for your wife or husband. Adding them can mean paying close to full price for their coverage through payroll, at the same group rate as a 55-year-old coworker's spouse.
If both of you are young and healthy, a separate private plan for your spouse, or for both of you, can sometimes cost less. Since 2023, whether family coverage is affordable is based on what you'd pay to cover the family, not just yourself, so depending on your income, your spouse might qualify for help there even if you don't. Either way, it's worth comparing before you sign up for the "employee + spouse" tier again.
Signs you're probably overpaying
You're a good candidate to compare if most of these sound like you:
- You're roughly 20 to 35 and in good health.
- You rarely go to the doctor and don't take ongoing prescriptions.
- A big amount comes out of each paycheck, or you're paying to cover a spouse.
- Your work plan has a high deductible you've never come close to meeting.
- You'd like a PPO so you can see doctors without referrals.
When I'll tell you to keep your work plan
Honest advice means telling you when not to switch. Keep your employer plan if:
- Your employer pays most of it. If your share for single coverage is small, it's very hard to beat.
- You have a health condition or regular medications. Private plans can decline you or exclude pre-existing conditions. Employer plans can't.
- You're planning a baby soon. Check maternity coverage closely. Many private underwritten plans limit or exclude it.
- You'd lose something that matters, like an HSA contribution from your employer, or a plan your family's doctors are in.
The fine print, said plainly
You give up your employer's share
The money your employer puts toward your premium is part of your pay. Most employers won't hand it to you if you skip the plan, so the comparison is your paycheck deduction versus the full price of a private plan.
You lose the pre-tax break
Most work plans take your share out before taxes through what's called a cafeteria plan (IRS Publication 15-B). A private plan is usually paid with after-tax money. If you're in a 22% tax bracket, $200 of pre-tax premium "costs" you about $140 to $156 out of pocket, depending on whether it also skips Social Security and Medicare tax. I build that into the comparison. Check the tax side with your tax preparer; this isn't tax advice.
Timing is locked
Payroll elections are normally fixed for the plan year. Most people can only drop their work plan at their employer's open enrollment, often in the fall, or after a qualifying life event. Private plans can usually start in any month, so we line up the start date to avoid a gap if you're approved.
Private plans are underwritten
Private medically underwritten plans ask health questions. They can decline an application, exclude pre-existing conditions, and don't have to cover every ACA essential health benefit. That's why they can cost less for healthy people, and it's why I walk through exactly what a plan covers before you apply.
Marketplace savings usually aren't available to you
If your job offers coverage that's affordable and meets minimum standards, you generally can't get Marketplace savings for yourself (HealthCare.gov). Most job-based plans meet those standards.
How I run the numbers
- Find your real cost. Grab a recent paystub. Multiply your health deduction by your number of paychecks. $150 every two weeks is $3,900 a year.
- Look at what you used. Doctor visits, prescriptions, anything coming up. Your plan's deductible and out-of-pocket max matter more than the premium if you use care.
- Quote private options for your age, state, and health, with the same or better doctor access.
- Compare after taxes, including what you'd give up, and pick the switch date around your employer's open enrollment.
If your work plan comes out ahead, you've lost nothing but a few minutes. If it doesn't, the savings can add up to real money every year.
Where I land
Being young and healthy is the one time the individual market is priced in your favor. Work plans don't care. If your employer pays most of your own premium, keep it and don't think twice. If a big chunk leaves every paycheck, or you're covering a spouse, it takes one comparison to know. Do it before your employer's open enrollment closes, because that's usually your only chance this year.
Send me the number off your paystub. I'll price it against private options and tell you which wins. Free, and no pitch at the end.
Questions I get
Can I drop my employer's health insurance whenever I want?+
Usually not. Paycheck deductions for health insurance are normally locked in for the plan year, so most people can only drop at their employer's open enrollment or after a qualifying life event like marriage or a new baby. Ask your HR team for your plan's rules before you change anything.
Is a private plan as good as my employer plan?+
It depends on the plan. Private medically underwritten plans can have broad PPO networks, but they're not required to cover every ACA essential health benefit, they can decline applicants, and they may exclude pre-existing conditions. I go through what's covered and what isn't before you decide.
Can I get a Marketplace subsidy instead of my work plan?+
Probably not for yourself. If your employer offers coverage that's affordable and meets minimum standards, you usually can't get Marketplace savings for you. Since 2023, family coverage is judged on what it costs to cover the family, so a spouse may qualify. I'll tell you if the Marketplace is the better route.
Does my employer have to pay me more if I drop their plan?+
No. Most employers don't pay you their share if you skip the plan. That money is part of what you give up, which is why I compare total cost, not just premiums.
Is it free to have you compare?+
Yes. Carriers pay agents, so working with me costs you nothing, and you're never obligated to switch.