Do I Need Individual Health Coverage If I Have a Family Plan?

health insurance


With so many health insurance policies available, choosing one can be a real pain. It is often quite difficult to decide which one will best suit you and your family.

People have many questions when it comes time to shop for a plan. A common one is whether or not some scenarios require you to purchase both an individual and a family health insurance plan.

In this article, we’re going to take a look at this question and more. Once done, you will know which one to opt for and whether or not you ever need both an individual and family health insurance plan.

Should I Purchase a Family or Individual Health Insurance Plan?

This depends on factors such as number of members in the family, the age of the eldest family member, if any person has a pre-existing conditions, medical history of the family, et cetera.

A younger family which includes a spouse and parents or those with a newborn child can usually opt for family insurance because the chances of health-related issues are less at a younger age. However, if you have a pre-existing illness or critical illness it may be better opting for an individual health insurance policy for you.

Mixing and matching is always an option. Sometimes it is ideal to get both a family health insurance plan and an individual plan. For example, if you have pre-existing conditions but your family does not.

Of course, the best way to determine which option is best for your unique situation, is to speak to each potential insurance provider to find out which offers the best combination of coverage and pricing.

Should I Buy Individual Health Insurance if I Already Have Family Health Insurance?

Various factors will affect your decision when it comes to this. Some of these are as follows:

  • A young family who does not have a pre-existing illness or any medical history in the family should typically opt for a family insurance policy. As the family health policy covers the entire family, the sum insured may be enough.
  • Health insurance policy for family is beneficial when there is no one with a medical history or any pre-existing illness, and you follow a healthy lifestyle, as it provides enough coverage for the entire family. But, other than that, or in case of emergencies, going with only a family insurance policy might not be enough.
  • If it is provided by your employer, it might not be the best family health insurance policy. There are many reasons for this. As a company has to provide the same policy for thousands of employees, the coverage provided may not be enough. Also, in case of any deprivation in the company, the coverage may be decreased. So, in such cases, a person should always opt for an individual health plan.
  • There are various exclusions in a family insurance plan which should always be considered while buying it. These are:
    • OPD charges are generally not covered in a family insurance policy.
    • Pregnancy issues such as miscarriage are not covered.
    • Any pre-existing illness is not covered during the waiting period.
    • Any injury or illness as a result of war, nuclear reactions, etc. are not covered.


Although family insurance provides coverage for the entire family under one plan and the premium is typically lower than individual health insurance, it may not be the best option for your needs.

For example, in case of critical illness emergencies, or due to an accident, the hospitalization and medical expenses provided by the family insurance might not be enough. In such cases, it may be better to also purchase an individual health policy too.

Sometimes purchasing a family plan to cover your family and getting an individual plan to cover yourself works best. Again, it will depend on your unique situation, such as do you have pre-existing conditions.

A potential scenario is that depending on the health insurance policy limits of your family plan, your individual medical care needs may actually exhaust the family plans maximums and thus a medical emergency in your family could leave you high and dry.

At the end of the day, deciding whether or not you should get an individual health insurance plan on top of a family one, is going to depend on your unique situation. Speak to a provider to determine what will work best for your needs.

About Theresa Duncan

Originally from Detroit, MI, Theresa has been offering health and fitness advice for the last 30 years while working as an engineer. She decided to turn her passion into a profession, and finds nothing more satisfying than helping others reach their health and fitness goals.

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