Navigating Insurance After Tying The Knot: A Guide To Policy Changes Post-Marriage

Marriage is considered a Qualifying Life Event, which means you can make changes to your current insurance coverage or enrol in a new plan outside of the regular enrolment period. Newlyweds have 60 days from their wedding day to enrol in a new health insurance plan, add their spouse to their existing plan, or join their spouse's plan. It's important to note that spouses do not have to be on the same insurance plan, but there may be financial benefits to sharing a plan. Couples should compare the costs and benefits of their respective plans to determine the best course of action. Factors to consider include monthly premiums, annual deductibles, in-network options, and additional options like disability or accident insurance.

Compare the costs of separate insurance plans with coverage together

When it comes to health insurance, newlyweds have a few options: they can be on separate insurance plans, or they can share a plan. Here are some things to consider when comparing the costs of these options.

Monthly Premiums

If you and your spouse are on separate insurance plans, you will each have to pay a monthly premium. If you share a plan, you will only have to pay one premium, which may be lower than the sum of the two individual premiums.

Annual Deductibles

It's important to compare the annual deductibles of the plans you're considering. A deductible is the amount you pay for health care before the insurance company starts paying. If you and your spouse are on separate plans, you will each have to meet your own deductible. If you're on the same plan, you will only have to meet one deductible, which may be lower than the sum of the two individual deductibles.

In-Network Options

It's important to check if the doctors you prefer are in the network for the plans you're considering. If you and your spouse are on separate plans, you may have access to a wider range of in-network doctors. However, if you're on the same plan, you may be limited to a smaller network.

Additional Options

Compare the additional options offered by the plans, such as disability or accident insurance, or reimbursement accounts to help save on eligible medical costs.

Prescription Drug Coverage

If one or both of you take prescription medications regularly, compare the prescription drug coverage offered by the plans. Some plans may have lower copays or cover a wider range of medications.

Travel Plans

If you and your new spouse enjoy travelling, a preferred provider organization (PPO) plan may be a better option, as they have wider nationwide networks. However, if you're planning to stay put, a health maintenance organization (HMO) network plan may offer lower premiums.

Medical Needs

Compare your own health needs with your spouse's. If one of you is generally healthier than the other, it may be more cost-effective for you to be on separate plans. The healthier spouse could choose a lower-cost plan, while the spouse with higher medical needs could choose a plan with more extensive coverage.

Out-of-Pocket Costs

Family plans tend to have higher out-of-pocket costs than individual plans. If you and your spouse are on separate plans, you will each have your own out-of-pocket limit. If you're on a family plan, you will have a single, higher out-of-pocket limit.

Check if your providers are included in your spouse's health plan

Getting married is considered a “Qualifying Life Event”, which means you can make changes to your current insurance coverage or enrol in a new plan outside of the regular enrolment period. Marriage also allows you to add your spouse to your existing plan or enrol in your spouse's plan.

When considering whether to join your spouse's health plan, it is important to check if your current healthcare providers are included in their plan's network. This is because each health insurance plan has a specific list of approved healthcare providers, known as a provider network, and it is usually more expensive to see doctors who are out-of-network. Therefore, if you wish to continue seeing your current doctors, you should check if they are included in your spouse's plan.

Additionally, you should also consider the following when deciding whether to join your spouse's health plan:

• Monthly premiums: Would changing plans increase your monthly premiums?
• Annual deductibles: Does your spouse's plan have a higher or lower deductible?
• In-network options: Are the doctors you prefer included in your spouse's plan network? Does the plan offer good options for hospitals or ER visits? Does it include benefits for pregnancy and childbirth care if you are planning a family?
• Additional options: Does the plan offer benefits such as disability or accident insurance, or reimbursement accounts to help save on eligible medical costs?

Consider the amount of travel when choosing a health plan

When it comes to choosing a health plan after marriage, there are several factors to consider. Firstly, it's important to note that marriage is considered a "Qualifying Life Event," allowing you to make changes to your current insurance coverage or enrol in a new plan outside of the regular enrollment period. You generally have about 60 days after your wedding to make these changes. Here are some key points to keep in mind when considering the amount of travel when choosing a health plan:

Travel Habits and Health Insurance:

• Frequency of Travel: If you and your spouse enjoy travelling or have a nomadic lifestyle, it's important to consider a health plan that offers nationwide or international coverage. Preferred Provider Organization (PPO) plans typically have wider networks that are suitable for frequent travellers.
• Health Maintenance Organization (HMO) Plans: If you plan to stay in one place for the foreseeable future, an HMO plan may offer lower premiums as they have smaller, localized networks of care.
• Assess Your Travel Needs: Consider the type of travel you engage in and the activities you participate in. If you plan to engage in adventurous activities or extreme sports, ensure your health plan covers these. Additionally, if you have specific health needs or pre-existing conditions, choose a plan that accommodates them.
• International Travel Medical Insurance: If you plan to travel abroad, research whether your current health plan covers you internationally. If not, consider purchasing travel medical insurance that includes emergency medical, evacuation, and repatriation benefits.
• Research Your Destination's Healthcare System: Understand how individuals in your destination country access healthcare and the availability of medical technology. Even if the country has socialized medicine, there may be waiting periods before you can access it.
• In-Network Providers: When choosing a health plan, consider the range of in-network medical providers available. PPO plans offer more provider options, while HMO plans may have smaller networks but provide more affordable premiums.
• Out-of-Pocket Expenses: Understand the out-of-pocket expenses associated with your health plan, including copays, deductibles, and coinsurance. When travelling, you may incur higher out-of-pocket costs if you seek medical care outside of your plan's network.
• Prescription Drug Coverage: If you or your spouse take regular medications, ensure your health plan covers these prescriptions. Different plans have varying coverage levels for prescription drugs, so it's important to compare and select a plan that meets your needs.
• Emergency Coverage: Consider the level of emergency coverage provided by the health plan, especially if you plan to travel to remote or rural areas. PPO plans typically offer more flexibility in accessing out-of-network providers in emergency situations.
• Compare Plan Options: Compare the premiums, deductibles, and coverage options between your respective plans. Consider the financial benefits of sharing a plan with your spouse versus maintaining separate coverage.
• Special Enrollment Periods (SEPs): Be mindful of timing when switching to your spouse's health plan or enrolling in a new plan. Special enrollment periods triggered by life events, such as marriage, allow you to make changes outside of the annual open enrollment period.

Discuss what medications you take and how much coverage you need

When it comes to health insurance after marriage, discussing the medications you take and how much coverage you need is essential. Here are some key points to consider:

Medication Needs:

Firstly, it's important to understand each other's medication needs. Do either of you take regular prescription drugs or medications? Making a comprehensive list of all the medications you both take will help you assess the coverage you'll require. Consider the following:

• Are the medications you take generic or brand-name? Generic medications are typically more affordable than brand-name drugs as they are often bioequivalent but cheaper.
• How often do you take the medication, and in what dosage? Sometimes, buying medication in bulk or opting for a 90-day prescription can reduce costs.
• Where do you purchase your prescriptions? Costs can vary significantly between pharmacies, so it's worth comparing prices.

Insurance Coverage:

Once you understand your medication needs, you can explore insurance coverage options:

• Review the formulary (the list of covered drugs) for each insurance plan under consideration. Ensure that the medications you need are included.
• Understand the cost structure. Some plans may have set amounts or copays, while others are less structured. Know what your out-of-pocket expenses might be.
• Compare premiums, deductibles, and out-of-pocket maximums between plans. Consider whether it's more financially viable to be on separate plans or the same plan.
• Check if your preferred doctors and healthcare providers are in the plan's network. Staying in-network is usually more cost-effective.
• Assess your travel plans. If you travel frequently, consider a plan with a wider network that suits your nomadic lifestyle.
• Consider special circumstances, such as family planning or chronic illnesses. Ensure that the insurance plan provides adequate coverage for your specific needs.

Remember, marriage is considered a "Qualifying Life Event," allowing you to make changes to your insurance coverage or enroll in a new plan outside the regular enrollment period. Take advantage of this opportunity to review and select the best insurance plan for you and your spouse, keeping your medication needs and coverage requirements in mind.

Think about whether you have the same medical needs as your spouse

Marriage is a significant life event that allows you to change your insurance plan or add your spouse to your plan outside of the open enrollment period. However, it is essential to consider whether you and your spouse have similar medical needs. Here are some factors to consider:

• Medical history: Are you both generally healthy, or are there any chronic illnesses or ongoing health issues that need to be addressed? Understanding each other's medical history can help you choose a plan that covers any pre-existing conditions and encourages investment in the right care.
• Medication needs: Discuss any medications that you take regularly and review how much coverage each insurance plan option provides. Some plans have set amounts or copays, while others are less structured. Understanding these differences can help you choose a plan that better meets your medication needs.
• Frequency of doctor visits: If either you or your spouse visits healthcare providers regularly, this may influence your insurance plan choice. Consider whether you want to continue seeing your current providers or don't mind switching to new ones. Finding a plan with a provider network that suits your needs is essential.
• Travel plans: If you and your spouse enjoy travelling, a preferred provider organisation (PPO) plan may be more suitable, as they have wider nationwide networks. However, if you plan to stay local, a health maintenance organisation (HMO) network plan may offer lower premiums due to their smaller, close-to-home networks.
• Cost comparison: Compare the costs of separate insurance plans versus a shared plan. Consider the monthly premiums, annual deductibles, and potential out-of-pocket expenses for each option. Additionally, look into any additional options, such as disability or accident insurance, or reimbursement accounts for medical costs.
• Provider networks: Check if your preferred doctors, specialists, and healthcare providers are included in the network of the insurance plans you're considering. Staying in-network can help you save money, so ensuring that your current providers are covered is important.

Frequently asked questions