Marriage unites many elements: hearts, homes, finances and health insurance plans. If each of you already has individual plans in place, combining them could have significant effects on both premiums and deductibles.
Marriage is considered an eligible life event and grants you a 60-day special enrollment period to modify or add your spouse to your plan.
Individual Plans
As with all aspects of marriage, health care requires extensive planning. If either of you currently has access to an employer-sponsored health plan, marriage may impact what coverage options are available and which option best fits into your new lives together. Therefore it’s crucial that both partners discuss options available before making their choice for life together.
After getting married, newlyweds often qualify for a special enrollment period that allows them to change their health insurance within 30 days of marriage. For additional changes or additions to policies though, employers have their open enrollment periods during which you can make necessary modifications.
Based on your needs and preferences, you may opt to purchase one individual plan while splitting the premium cost with your spouse. This could be useful if medical conditions make meeting family deductibles difficult; otherwise a combined plan with coverage for both of you could prove more cost effective.
Many couples opt to share individual plans when they get married; however, this decision should be made jointly in consultation. Aside from cost considerations, other key points include preexisting medical conditions or needing extensive provider networks; considering future childbirth may also factor into your decision as qualified plans typically include maternity coverage as part of the Affordable Care Act.
If you and your partner both qualify for Medicaid or another government-funded health plan, marriage won’t have any adverse affect on eligibility as long as both incomes remain below the income cutoff for your state. If there is any concern that higher earnings might force out eligibility, contact your state Medicaid agency to understand their rules for your specific location.
Navigating the choices available to married people who each possess individual health insurance plans can be challenging, but eHealth can make the task simpler. We help people across all 50 states find health coverage that fits both their budget and healthcare needs, including licensed health insurance brokers who can assist with choosing a plan after marriage or major life changes.
Family Plans
Your wedding can be an exciting, life-altering moment in your life – but it could also come with some financial ramifications. Marriage could affect how you qualify for health insurance; depending on your income and tax filing practices, marriage could disqualify you from receiving subsidies through the Affordable Care Act marketplace.
Good news if your marriage occurs before open enrollment for your employer’s group plan ends: it won’t result in losing health insurance! Instead, as weddings qualify as qualifying life events allowing a special enrollment period within 60 days after your marriage to enroll in new plans.
At this stage, you have several options for adding or switching plans with your spouse: either expanding the current plan to include more benefits at reduced costs; or opting for separate individual policies if desired.
At this time, you may also be eligible to sign up for individual plans through the Affordable Care Act Marketplace. Use their online enrollment tool to browse available plans and compare costs and coverage before selecting one that meets your needs and choosing your payment method – generally by the end of this month so coverage starts up again the following month.
If both you and your spouse share similar medical needs, consolidating individual policies into one family plan could save on premiums by consolidating deductibles; just make sure it doesn’t become too high! If medical costs become excessively costly for either of you.
If your medical expenses are relatively modest, make sure that the monthly premium for your individual plan does not fall too low. Ideally, they should cover at least the minimum coverage level required; in certain instances they could even go beyond this minimum to receive financial help from government programs.
Exchange Plans
Marriage will not impact health insurance plans available through work; however, marketplace plans purchased individually could change depending on life events such as getting married. You could take advantage of a special enrollment period in case any life events qualify, like getting engaged or losing other coverage.
Once you get married, it may be necessary to review and compare prices on individual plans. Your annual deductibles and monthly premiums may change when adding your spouse to an existing plan, yet adding them could actually end up costing less than starting from scratch.
Marriage may alter both individual plan options and eligibility for Medicare or Medicaid benefits. Because your household income changes with marriage, this could put you into higher eligibility brackets for Medicare or Medicaid eligibility. Furthermore, both partners need to determine if they’ll both qualify for maternity benefits which come standard in all Qualified Health Plans.
If your employer offers family plans, then you have two choices for coverage: either remain with the current plan if both members of your household are healthy and have met all annual deductibles; or purchase an option that offers both maternity and newborn coverage.
Your own health insurance can be purchased through either a state or federal marketplace, also known as an exchange. With exchanges receiving government funding in the form of premium subsidies, such as subsidies on plans, you have options when selecting plans that will maximize your subsidy amount and can even combine plans into one policy for each spouse if applicable. Choosing plans that maximize this subsidy makes sense if filing tax returns together will also require filing jointly.
Medicare
Marriage status changes can have significant ramifications on Medicare coverage and eligibility for programs like Extra Help that reduce drug costs for people with lower incomes. A change may entail changes to premiums, copayments and coinsurance costs as well as eligibility for Extra Help programs like LIS that help lower drug costs for these groups of beneficiaries.
Before getting married, couples should discuss their individual insurance needs and consider any possible effects of marriage on those plans. They might also look into consolidating individual policies into one family plan which typically provides discounts since it covers more than one person.
If a couple is covered by their employer for health insurance, getting married could change their options significantly. Depending on state laws, their spouse could gain access to individual or family plans through their health insurance marketplace; or enroll in Medicare during a special enrollment period which begins on the date of marriage and continues for 60 days post nuptial.
Spouses without employer-sponsored health insurance might choose to delay Part B enrollment while remaining covered under their partner’s plan, to avoid incurring penalties for late enrollment in the future. If they choose this approach, it is important to make sure their partner allows access to their doctor and allows for seamless continuity of care as well as controlling copayments and coinsurance premiums.
Once married people retire, they may wish to opt-out of premium Medicare Part B in favor of premium-free Part A; this is often considered the optimal decision. Individuals wishing to do this should use form CMS-L564 during the SEP for Working Aged and Disabled, or form CMS-1763 due to End Stage Renal Disease.
Marriage dissolution can also serve as an SEP to sign up for Medicare prescription drug coverage known as Part D. Newlyweds should take this opportunity to research their options and select an ideal plan, since their next open enrollment period won’t happen until November of 2022.