The Evolution Of Insurance After Tying The Knot

Marriage is a significant life event that can change your insurance options and coverage. Newlyweds can choose to stay on separate health plans or combine their insurance plans. Combining insurance plans can be done through one spouse's employer or by finding a new plan together on the individual market. While it is not always the most affordable option, having a family health insurance plan can offer discounts. It is important to consider the costs and benefits of switching insurance plans, as there may be unexpected costs associated with purchasing a plan through an exchange.

Adding a spouse to your insurance plan

Adding a spouse to your health insurance plan is a relatively simple process, but it can only be done during certain times. Here's what you need to know about adding a spouse to your health insurance plan:

Timing is crucial

Generally, you can only add your spouse during the annual open enrollment period. However, getting married is considered a "qualifying life event", which allows you to make changes to your health insurance within a certain time frame after your wedding. This is known as a Special Enrollment Period (SEP).

The duration of the SEP varies, but it is typically between 30 and 60 days from the date of your wedding. If you miss this window, you will have to wait until the next open enrollment period to make any changes.

Required documentation

To add your spouse to your health insurance plan, you will need to provide certain documents, such as:

• A copy of your marriage certificate
• Proof of your spouse's loss of insurance (if applicable)
• Enrollment change form
• Spouse's personal information (e.g., birth date, social security number)

Compare plans and costs

Before adding your spouse to your health insurance plan, it is important to compare the costs and benefits of both your plans. Consider the following:

• Out-of-pocket maximums
• Insurance company reputation
• Premiums
• Deductibles
• Plan maximums
• Co-payments
• Spousal surcharges
• Levels of coverage
• Coverage for dependent children

By comparing these factors, you can determine whether it is more cost-effective to add your spouse to your plan or maintain separate policies.

Contact the relevant departments

To initiate the process of adding your spouse to your health insurance plan, you should contact your employer's Human Resources (HR) department or the insurance company directly. They will be able to guide you through the specific steps and requirements for making changes to your coverage.

Explore other options

If you are unable to add your spouse to your health insurance plan or prefer alternative options, there are a few other avenues to explore:

• Your spouse can enroll in their own health insurance plan through their employer or the individual market.
• You and your spouse can find a plan together on the individual market.
• If eligible, your spouse can remain on their parents' health insurance plan until they turn 26 years old, regardless of their marital status.

Switching to a spouse's insurance plan

Marriage is a major life event that can have a significant impact on a couple's insurance coverage. Here are some important considerations and steps to take when switching to a spouse's insurance plan:

Understanding Insurance Options:

Before making any changes, it is crucial to explore and understand both spouses' insurance options. Compare the benefits and costs of each plan, including premiums, deductibles, coinsurance, and copayments. Additionally, consider the network of providers associated with each plan to ensure your preferred doctors and specialists are covered.

Timing and Enrollment Periods:

The easiest time to switch to a spouse's insurance plan is during the annual open enrollment period. Most companies' open enrollment periods typically begin in November, with coverage starting on January 1st of the following year. Ensure that both plans have the same plan year and effective date to avoid any gaps in coverage.

Outside of the open enrollment period, changing to a spouse's policy can be more challenging and may result in a refusal of coverage until the next open enrollment period. However, certain life events, such as marriage, birth or adoption of a child, divorce, or loss of health coverage, may trigger a Special Enrollment Period (SEP) that allows you to make changes outside the regular enrollment window.

Switching Coverage:

During the open enrollment or SEP, switching to your spouse's insurance plan is generally a simple process. Contact the relevant insurance provider or HR department to initiate the change. You will typically need to cancel your current plan and enrol in your spouse's policy. If you are switching from group health insurance to an individual or family plan, confirm the requirements, especially if either employer offers a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) or an Individual Coverage HRA (ICHRA).

Cost Considerations:

When deciding whether to switch to a spouse's insurance plan, consider the potential cost savings. Combining insurance plans may result in lower premiums and out-of-pocket expenses. However, some employers may charge a "spouse surcharge" if the spouse has access to their own insurance but chooses to join their partner's plan.

Paperwork and Verification:

When switching insurance plans, be prepared to provide the necessary documentation, especially during a SEP. You may need to submit proof of your change in circumstances, such as a marriage certificate, within a specified timeframe.

Secondary Coverage:

If you decide to keep your original insurance plan as secondary coverage, be aware that insurance companies designate the primary plan based on the spouse's birthday, with the plan of the spouse whose birthday occurs first in the year considered primary.

State-Specific Rules:

Remember that insurance regulations and options may vary depending on your state of residence. Always review the specific rules and options available in your state when considering switching to a spouse's insurance plan.

Staying on separate insurance plans

Affordability

Spouses do not have to be on the same insurance plan. If one spouse's plan becomes unaffordable when the other is added, it may make sense to maintain separate policies. In some cases, separate policies may be the best option, especially if both spouses can enrol in a health plan through their employers.

Medical Needs

If one spouse has more extensive medical needs than the other, it may be more cost-effective for the couple to have separate insurance plans. For example, if one spouse has a health condition that requires ongoing care, choosing a separate insurance policy might save money.

Out-of-Network Care

If one spouse needs to travel more than the other, they may want to ensure their plan provides the best coverage possible when they are away from home. Having separate insurance plans can give them this flexibility.

Doctor Preferences

Each spouse may have a preferred doctor, specialist, or hospital. Purchasing individual plans may cost more out of pocket and for premiums, but this may be worthwhile to get access to preferred providers.

Health Savings Accounts (HSAs)

If one spouse has an HSA-qualified plan and the other has a plan that isn't HSA-qualified, the HSA contribution will be limited to the self-only amount. In 2024, the HSA contribution limit for an individual is $4,150, while the limit for family coverage is $8,300.

Spousal Surcharge

Some employers charge a spousal surcharge, which is an additional cost on top of regular premiums, if an employee's spouse has access to coverage from their employer but chooses to be covered under their spouse's plan. This could make it more expensive for the couple to be on the same plan.

Paperwork and Administration

Having separate insurance plans may result in more paperwork and administration. However, this may be a minor inconvenience compared to the potential cost savings of separate plans.

In conclusion, there are several factors to consider when deciding whether to stay on separate insurance plans after marriage, including affordability, medical needs, access to preferred providers, and potential surcharges. Couples should carefully weigh their options and choose the insurance plans that best suit their needs and budget.

Finding a new plan together on the individual market

Marriage is a major milestone and a qualifying life event (QLE) that allows you to make adjustments to your insurance benefits. Newlyweds have several options when it comes to their health insurance, and finding a new plan together on the individual market is one of them. Here are some key considerations for navigating the process:

• Timing is crucial: Marriage is considered a QLE, which means you have a limited window to make changes to your insurance. Typically, you have up to 60 days after getting married to enroll in a new plan or make changes to your existing coverage.
• Explore your options: Research the individual market for health insurance plans that suit your needs and budget. Compare the costs, coverage, and benefits offered by different insurance providers. Consider factors such as copayments, coinsurance, and out-of-pocket maximums. Ensure that your preferred doctors and prescription medications are included in the plan's network.
• Understand the benefits of individual plans: Individual health insurance plans can offer flexibility and cost savings. By being on separate plans, you can each choose a plan that best suits your individual needs, especially if one spouse has chronic health issues. Additionally, separate plans can reduce the risk of losing coverage if one spouse loses their job.
• Weigh the convenience of a joint plan: Being on the same plan can simplify insurance management and may be more economical. It reduces paperwork and makes it easier to track your coverage and benefits. Additionally, some plans offer advantages when individual expenses count toward a family deductible.
• Consider combining other insurance policies: Besides health insurance, explore combining your car, life, and home insurance plans. Consolidating insurance policies can often result in discounts on monthly premiums and simplify your financial management.
• Seek professional guidance: Consult a licensed insurance broker or financial advisor to help you navigate the complex world of insurance options. They can provide valuable insights and ensure you make informed decisions that align with your financial goals.
• Be mindful of special enrollment periods (SEPs): Keep in mind that changing your insurance outside the annual open enrollment period can be challenging. SEPs triggered by QLEs allow you to review your options and enroll in a new plan outside the regular enrollment period. Remember to provide the necessary documentation, such as a marriage certificate, within the specified timeframe.

Buying insurance from a marketplace or broker

Marriage is considered a "qualifying event", which means that an employee can change their health insurance plan up to 60 days after getting married. If you are looking to buy insurance from a marketplace or broker, there are a few things to keep in mind.

Firstly, it is important to understand the difference between a marketplace and a broker. A marketplace is a government-run platform, such as the Affordable Care Act (ACA) Marketplace, where you can shop for insurance on your own without an intermediary. On the other hand, a broker is a licensed health insurance agent who can help you compare and purchase plans from various insurance companies, including those inside and outside the marketplace.

There are several reasons why you might choose to use a broker. Brokers can provide personalized help and recommendations, especially if you are looking for a non-ACA-compliant plan. They can also assist you in comparing ACA-compliant off-exchange plans with those available through the marketplace. This can be beneficial if your income is too high for subsidies, as brokers can help you find the best plan for your needs. Additionally, brokers can be a valuable resource after you purchase a plan, as you can turn to them with any questions or concerns about your policy, network, or claims.

However, it is important to note that using a broker is not mandatory. You can purchase a marketplace plan without a broker, and there is no additional cost for shopping on the marketplace through platforms like HealthSherpa. The marketplace offers a wide range of options, and you may qualify for premium tax credits that lower your monthly premiums.

When deciding whether to use a broker or shop on the marketplace, consider your specific needs and preferences. Brokers can offer personalized assistance and access to a wider range of plans, but the marketplace provides a user-friendly platform with potential cost savings.

Frequently asked questions