Alyssa Lane
If you're looking to get medical insurance for your spouse and yourself, there are a few options available to you. Marriage is considered a qualifying event, which means you can make changes to your health insurance within 30 days of getting married. You can either add your spouse to your existing plan or register in the health insurance marketplace. You can also opt to be on your spouse's plan as a form of secondary insurance, but this can be quite expensive. It's important to do the math and compare the policies that you currently have, including any subsidies you receive. If one of you already has health insurance through an employer, you may be able to add your spouse to that employer-sponsored plan. However, small businesses and part-time employers are not legally required to offer health insurance, and large employers are only legally obligated to offer coverage to employees, not spouses. You may also want to consider separate plans based on specific medical needs, especially if one spouse has a health condition that requires lots of care.
| Characteristics | Values |
|---|---|
| Options for getting medical insurance | Spouses can be covered under the same plan or separate plans. |
| Spouses covered under separate plans | Spouses can have their own Health Savings Accounts (HSAs) and split the total family contribution between the two accounts. |
| Spouses covered under the same plan | Spouses can be covered under a family plan. |
| Cost of coverage | Spouses should compare the costs of their policies against the cost of a family plan to ensure that both the price and coverage are better than what they are currently receiving. |
| Spouse with a health insurance plan available at their employer | An employer will charge more for a family health insurance plan if it knows that a spouse has a health insurance plan available at their own employer. |
| Spouse losing their insurance coverage | The other spouse can join their partner's health plan or shop for an individual health plan online. |
| Spouse with a chronic health issue | Spouses with chronic health issues might benefit from lower-deductible plans. |
| Spouse with a health insurance plan through their employer | They can add their spouse to their healthcare plan during Open Enrollment. |
| Spouse with no health insurance | They can be added to their spouse's health insurance plan within 30 days of the wedding. |
| Spouse with a health insurance plan through the Affordable Care Act (ACA) | They can add their spouse to their healthcare plan during Open Enrollment. |
| Spouse with a health insurance plan through their employer and their spouse is unemployed | The unemployed spouse can be added to their partner's employer-sponsored health insurance plan. |
| Spouse with a health insurance plan through their employer and their spouse has their own health insurance plan | The spouse with insurance through their employer can add their spouse to their employer-sponsored plan. |
| Spouse with a health insurance plan and their spouse has no insurance | Their spouse can opt to go on their partner's insurance as a form of secondary insurance. |
| Spouse with a health insurance plan and their spouse has no insurance but is a victim of domestic abuse, domestic violence, or spousal abandonment | They can say they are "unmarried" on their Marketplace application without fear of penalty for mis-stating their marital status. |
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What You'll Learn
Adding your spouse to your insurance plan
There are several options available when it comes to getting medical insurance for yourself and your spouse. You can choose to be on separate plans or opt for a joint family plan. Here are some key points to consider when adding your spouse to your insurance plan:
Timing
Most health insurance plans allow you to add your spouse during the annual open enrollment period. This period typically occurs once a year and lets you add, remove, or make changes to your coverage. Open enrollment generally begins in November for coverage starting in January, but it can vary by company. It is important to check with your company's benefits department to confirm the specific dates.
Qualifying Life Events
Certain life events, such as marriage, childbirth, change in employment, or a spouse losing their health coverage, are considered qualifying events that allow you to make changes to your health insurance plan outside of the open enrollment period. You usually have a limited time frame, often 30 to 60 days, after the qualifying event to add your spouse to your plan. You may need to provide documentation, such as a marriage certificate or a letter from your spouse's employer, to verify eligibility.
Cost Considerations
Before deciding to join your spouse's health plan, it is essential to compare the costs and features of your existing plans. Joining a spouse's plan may result in higher monthly insurance bills (premiums) than having separate plans. Additionally, consider the stability of your jobs and review the list of providers to ensure that your current doctors are covered by the plan you choose.
Domestic Partnerships
If you are in a domestic partnership, it is important to note that not all states recognize this status. Even in states that do recognize domestic partnerships, it may be up to your employer or health plan to decide whether they will allow you to add your partner to your plan. You may need to provide proof of your domestic partnership through letters from family and friends, shared residence, and shared household costs.
Secondary Insurance
If you already have health insurance, you can opt to go on your spouse's plan as secondary insurance. In this case, your primary insurance will pay its share of your medical costs first, and then the remaining bill will go to your secondary insurance. While having two insurance plans can be helpful in unexpected medical situations, it can also be expensive, so carefully review the policies before making a decision.
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Choosing separate plans
There are several factors to consider when choosing separate health insurance plans for yourself and your spouse. Firstly, it's important to evaluate your specific medical needs. If one of you has a health condition that requires regular care, opting for separate plans might be more beneficial. Individual plans typically have lower deductibles, meaning the person with higher medical expenses can meet their deductible faster and have a larger portion of their medical costs covered.
Secondly, the stability of your jobs is a crucial consideration. Employer-sponsored health plans are common, but job instability or sudden loss of employment can disrupt your health coverage. In such cases, short-term medical insurance can be a temporary solution, and you won't necessarily have to wait for open enrollment to obtain it. However, if your spouse loses their job and their health insurance, you can add them to your plan during a Special Enrollment Period (SEP), which usually lasts for 30 to 60 days after a qualifying life event.
Thirdly, the availability of high-quality employer-sponsored plans should be assessed. If one spouse has access to an excellent employer-sponsored plan with reasonable premiums that can cover both of you, it might be more cost-effective to join that plan. However, if both plans are comparable, it may be more prudent to retain separate coverage. Additionally, if one spouse is eligible for government-sponsored insurance, such as Medicare or Medicaid, due to age or disability, they will have separate coverage, and you may want to maintain your own plan.
Another factor to consider is the network of providers included in each plan. If your preferred doctors and local hospitals are not in your spouse's health plan network, it might be more convenient and practical to maintain separate insurance plans. Furthermore, if you have a Health Savings Account (HSA) or are interested in opening one, be aware that contribution limits are higher for family coverage under an HSA-qualified high-deductible health plan. If you have separate insurance plans, you'll be limited to the "self-only" coverage contribution limit.
Lastly, the cost implications of combining plans should be carefully calculated. While adding your spouse to your plan is an option, you may be subject to a “spousal surcharge” if your employer knows your spouse has insurance available through their employer. This additional fee could eliminate any potential cost savings from combining plans. It's essential to compare the costs and features of your current plans, including any subsidies or tax credits you receive, to determine the most financially prudent option.
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Employer-sponsored plans
Employer-sponsored health insurance plans are a common way for Americans to secure health coverage. Nearly 60% of Americans with health coverage are covered by an employer-sponsored plan, also known as group health insurance. Under the Affordable Care Act (ACA), employers with at least 50 full-time employees are generally required to provide health insurance to their workers. Employers with fewer than 50 full-time employees are not mandated to provide coverage but may qualify for the Tax Credit for Small Employer Health Insurance Premiums if they choose to do so.
If you and your spouse both have employer-sponsored health insurance, you have a few options. You can each remain on your separate individual plans, or one spouse can join the other's plan as secondary insurance. If you choose to join your spouse's plan, you can do so within 30 days of your marriage. This time frame may vary depending on your employer, so be sure to check with your HR department. You may also need to provide documentation, such as a marriage certificate. Alternatively, if you each have access to a family plan through your employer, you can compare the costs and features of each plan to determine which option provides the best coverage for both of you at the lowest cost. It's important to note that some employers may charge a ""spousal surcharge"" for a family plan if they know that your spouse has access to a health insurance plan through their own employer. This fee may offset any potential cost savings of combining plans.
If you lose your job and your health insurance, you can join your spouse's plan outside of the open enrollment period. Additionally, if your spouse loses their insurance coverage, they can join your plan at any time. You can also shop for an individual health plan online or contact a licensed insurance agent for more information. If you choose an ACA plan, you may be eligible for subsidies depending on your household income.
When considering employer-sponsored health insurance, it's important to review the stability of your employment. If your job is unstable, it could disrupt your health coverage. Additionally, it's worth considering the level of care each person requires. Individual plans have lower deductibles, so if one spouse has a health condition requiring significant care, it might be more cost-effective for them to remain on their own plan.
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Self-employed insurance options
If you are self-employed, you can use the individual Health Insurance Marketplace to enroll in flexible, high-quality health coverage. This is a good option if you run your own business, are a freelancer, consultant, independent contractor, or other self-employed worker with no employees. You can also use the SHOP Marketplace for small businesses if your business has at least one employee (other than yourself, a spouse, family member, or owner). When you fill out a Marketplace application, you will have to estimate your net self-employment income, and you may qualify for premium tax credits and other savings on a health plan.
Short-term health insurance plans are also an option for self-employed individuals with no employees. These plans are medically underwritten and do not cover pre-existing conditions. They are designed to provide up to four months of coverage in a 12-month period while you consider long-term options.
If you are self-employed and are married, you can add your spouse to your health plan. Marriage is considered a "qualifying event," allowing you to make changes to your health insurance within 30 days. You can also opt to go on your spouse's plan as a form of secondary insurance, but this can be quite expensive. It is important to compare the costs and features of different plans to make an informed decision.
If you are self-employed with a family, there are individual and family plans available through the Health Insurance Marketplace. These plans may be eligible for a Premium Tax Credit (PTC), which can help reduce the monthly premium.
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Health Savings Accounts (HSAs)
A Health Savings Account (HSA) is a tax-efficient way to save for qualified medical expenses. HSAs are exclusive to those with a qualifying health plan, such as a high-deductible health plan. You are not eligible if you have healthcare coverage beyond qualified health plans (including Medicare enrollment) or if you are claimed as a dependent on someone else's tax return. HSAs are also not available to those receiving Veterans Affairs benefits within the past three months.
HSAs are member-owned accounts, meaning that the entire balance rolls over every year, even if you change health plans, retire, or leave your employer. This is in contrast to Flexible Spending Accounts (FSAs), which are owned by the employer. HSAs can be used to pay for copays, prescriptions, dental care, contacts and eyeglasses, bandages, X-rays, and more.
You can make pre-tax contributions to an HSA, which reduces your taxable income. The money in the account is also not taxed, even if it earns interest or investment returns. If you use the funds for qualified medical expenses, you won't owe taxes when withdrawing money from the account. This makes HSAs "triple-tax advantaged".
You can open an individual HSA account if you have a high-deductible health plan on your own (not through an employer). You can also have multiple HSAs, for example, one for investing and another for cash to pay for medical expenses.
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Frequently asked questions
There are several options for medical insurance for spouses. You can add your spouse to your existing health insurance plan, or vice versa. Alternatively, you can each remain on your own plans. If neither of you has insurance, you can purchase a new plan together or separately.
Being on the same insurance plan as your spouse can be more cost-effective, especially if you have children. However, it is important to consider each spouse's medical needs, as individual plans may be preferable if one spouse requires more medical care.
If you and your spouse are on separate insurance plans, you may face higher out-of-pocket costs overall. This is because the family out-of-pocket limit only applies if the family is covered under a single policy.
