Marriage can be an emotional process, and couples often face questions regarding health insurance options when planning a joint effort. Some couples opt to consolidate coverage while others maintain individual policies.
Understand your options and select the optimal healthcare policy for your family is essential, and to do that you’ll need to understand a few key differences between single and couple health insurance plans.
Cost
Reasons why spouses may decide to purchase separate health insurance plans can range from coverage offered by employers, eligibility for government-run programs like Medicare and Medicaid eligibility requirements and personal preference. Sometimes having two separate policies makes sense in order to save money or access better coverage options.
Depending on the circumstances, it may make financial sense for one spouse to opt out of an offer from a company’s plan that offers equivalent coverage but costs less than another’s offer if that spouse can find doctors in both provider networks or wants to avoid paying higher premiums for unnecessary coverage.
Cost should never be the sole determining factor when making decisions regarding whether to combine or maintain separate health insurance plans, however. Factors to take into account may include doctor preferences, medical needs and out-of-pocket expenses; thus couples should have an open dialogue before reaching a decision.
Coordination of benefits rules are guidelines that outline how two health insurance policies interact when paying for medical services. While each insurer’s rules may differ slightly, generally speaking the primary policy pays first before any remaining balance is covered by secondary policies; this practice is known as “coordination of benefits.”
Each spouse should select an insurance plan that best meets their healthcare needs, such as high quality coverage with lower deductibles but more costly premiums for example if one spouse uses healthcare more frequently than the other.
Tax deductions and savings options should also be carefully considered when choosing the ideal plan. Some plans offer the ability to contribute pre-tax earnings directly into a health savings account (HSA), with this account belonging to the primary planholder; if both spouses choose one plan together however, contributions to an HSA can be shared equally between them.
Coverage
Couples typically opt for shared health coverage in order to save money, but sometimes it may make more financial sense for both individuals to select separate plans based on doctor preferences and medical needs. When considering this decision, make sure all your doctors are included within both of the plans under consideration; additionally, ensure your plan addresses any essential medical requirements such as mental health.
If you have access to multiple healthcare options, it can be helpful to compare costs and coverage between them. Many employers provide various plans that allow employees to find one that best meets the unique needs of their family. Other people have the option of purchasing individual or family plans through state exchanges; using our tool can help you compare them all and decide which plan makes the most sense in terms of budgeting goals and outcomes.
When two plans exist simultaneously, how they’re paid depends on which is primary and has lower out-of-pocket costs. COB is used to determine which plan pays first and determines your out-of-pocket costs; you should review both plans’ provider networks to ensure you and your spouse can continue visiting doctors who are covered by both.
Another advantage to maintaining separate plans is having access to better healthcare options if you get your own policy. For instance, having a great employer-sponsored plan might make it hard for you to afford premiums on both plans without incurring an spousal surcharge fee.
If you are married, 60 days after the wedding date are typically allowed for adding your partner to healthcare coverage unless it’s Open Enrollment Period (OEP). While changes can be made at any time during the year, be sure to speak to HR representatives from both work environments to understand how this change impacts benefits. You may also consider purchasing short-term health, accident, or critical illness policies in addition to traditional coverage for unexpected expenses until new coverage kicks in.
Coordination of Benefits
Maintaining separate health insurance policies may make more sense in certain instances, particularly if each spouse has different healthcare needs and preferences. You could save money on premiums by opting for individual plans; additionally, each spouse could access more provider networks.
Many plans include coordination of benefits for married or domestic partners and their children, with your plan considered primary for you and any dependents while your spouse’s plan takes secondary status. Coordination also dictates coverage for out-of-network treatments; for instance if one plan covers 50% and another the remaining 50%; this determines how coverage applies when attending out-of-network treatments such as visits to doctors outside their network.
Unmarried couples frequently opt to maintain separate health insurance plans for various reasons. One common goal may be accessing their desired healthcare providers; for instance, one partner may prefer in-network doctors while their partner prefers out-of-network ones.
No matter the circumstances, always thoroughly review your policy documents when considering adding a spouse or life partner to your plan. Informed decisions based on current and anticipated healthcare needs will allow for informed choices to be made.
Before adding a spouse or life partner, you should assess your budget and premium costs before expanding coverage. While combining plans may save money overall, be sure to compare costs carefully before making your decision. Keep in mind that depending on the employer-provided plan you may also be subject to paying an additional surcharge fee for added spouse coverage.
Many individuals are unaware of the fact that it is possible to hold both individual and family health insurance policies simultaneously, especially for certain industries such as law enforcement or the military. Furthermore, divorced parents can continue covering their children through a parental plan until they turn 26 years old even though neither spouse has health coverage themselves.
Adding a Spouse
Decisions on whether or not to join your spouse’s health insurance plan is ultimately up to each partner individually, although sometimes joining forces can save money and make sense under certain conditions. Before making such a commitment, however, it’s wise to carefully weigh all options available before adding your partner as an addition to your health policy.
Married couples typically can only change their health insurance plans during an open enrollment period or special enrollment period (SEP), which are both provided to specific situations. Individual health plans tend to be more expensive than shared family policies in terms of both premium costs and monthly premium payments.
Due to these advantages, many married couples opt for joint family insurance policies rather than buying individual plans. This can be accomplished in various ways including individual marketplaces or employer benefits offerings; however it should be remembered that merging policies may cause coverage issues as well as financial penalties from health insurance providers.
Some employers provide spousal coverage as part of their employee benefit packages, providing couples with an economical solution for comprehensive medical coverage for themselves and their families. Deductibles and co-payments tend to be lower when both have one plan rather than having individual policies.
Likewise, should one spouse experience illness or injury that requires significant medical treatment, their partner can use their health insurance as secondary coverage to avoid going into debt or having to cover the entire bill by themselves. This may help save both parties time and money in terms of expenses associated with hospital visits or bills for physical therapies and care costs.
Subscribing a spouse to health insurance policy can be relatively straightforward. Most employers allow employees to add them during an open enrollment period, typically two or three weeks long and lasting one or two months, during which employees can review options, pose any queries they might have and enroll for next plan year. Some employers may charge an additional fee for spouses added outside open enrollment or through SEPs.