Is it better to join your spouse’s health plan or stick with your own plan — or do both?

Did you just get married? If you’re wondering whether it’s a good idea to join your spouse’s health plan, you’re not the first newlywed to do so.

Thankfully, when it comes to health insurance, you have options when you’re married. These could include, sticking with your own health insurance, joining your spouse’s health insurance plan, or keeping your health insurance and signing up for your spouse’s plan.

Which option is best for you may depend on factors such as cost, coverage and your individual family situation. Additionally, there are restrictions, such as when you can sign up or change your plan. Plans through an employer, the Affordable Care Act (ACA) or private insurance have different considerations.

Let’s take a look at common questions about how the process works, along with the pros and cons of specific options.

You don’t have to wait for open enrollment to get short-term medical insurance. In many cases, you can get covered as early as the next day. Find out how.

Can my spouse and I be on different health insurance plans?

Yes. In fact, you might need to be. If you’re eligible for your own employer-based insurance, your spouse’s employer doesn’t have to offer you coverage. Even if this isn’t the case, you both may want to stick with your own health care plans. Joining your spouse’s plan may be more expensive than paying 2 individual monthly bills (i.e., premiums) and out-of-pocket costs.

Can you add a spouse to health insurance at any time?

No. You can only join your spouse’s health plan during the annual Open Enrollment Period (OEP) or a Special Enrollment Period (SEP). Here’s how each one works:

OEP/employer enrollment period: If you have an ACA plan, the OEP typically takes place between November 1 and January 15, depending on your state. During that time, you can enroll in a new health plan, renew your current plan or make changes to your existing plan.

If you or your spouse has employer-based insurance, your employer will provide its own annual enrollment window. For example, you may be able to switch carriers or change your type of plan during it. You can also add a spouse or dependent to your plan. Employers often hold open enrollment in late fall, with changes taking place in the next calendar year, but you’ll want to check with your company’s human resources department on timing to make sure.

SEP: Outside of open enrollment, your spouse can add you to their plan if you experience a qualifying life event. That opens a special enrollment window. Examples of a qualifying life event include but are not limited to:

• Changes in income that effect the type of coverage you qualify for
• Getting married or divorced
• Giving birth to or adopting a child, or gaining a dependent child through marriage
• Losing health insurance (either spouse)

If a qualifying event occurs, you can make the sort of changes that you would be eligible to make during the normal Open Enrollment Period — or your employer’s enrollment period. However, you will only have a limited amount of time from the date of the event — usually 30 or 60 days — to make any change.

Can I keep my own health insurance and join my spouse’s plan?

Yes, you can have dual enrollment in your own and your spouse’s health plans. If you do, the plans will do what’s called coordination of benefits.

• Your plan will be the primary one. It will process your claims just like it does now, paying its share of your medical bills.
• Your spouse’s plan will be the secondary one. It will pay some or even all the remaining costs, such as any copayments (those are fixed amounts you pay for covered health services).
• Your secondary insurance may pay for services that your primary plan does not. For example, your secondary insurance may cover a brand-name medication that your primary insurance doesn’t cover.

Short-term medical insurance may provide you and your spouse with coverage for doctor’s office visits, prescriptions, hospital stays and more. Find out more about this affordable option now.

Should I sign up for my spouse’s health plan?

Critical factors to consider when deciding whether you want to join your spouse’s health plan are cost, coverage and your individual family situation.

Look at your potential out-of-pocket costs — not just the monthly premiums — and do the math. Considerations include:

• Your deductible. That’s how much you pay out of pocket before insurance pays its portion. There’s typically an individual deductible and a family deductible.
• Your coinsurance or copayments. They may be a percentage of the cost, such as 20% of an emergency room bill (coinsurance) or a set amount, such as $25 per office visit (copayment).
• Your network. Seeing in-network providers will typically cost less than seeing providers who are out of network.
• Your annual limit. This is a cap on the total you will pay out of pocket for a year. There are typically an individual limit and a family limit.

When it comes to health coverage, consider not just your needs today but also potential ones in the future.

• Read the fine print. Your plan’s print or online brochure will describe in detail what it covers. It might be a good idea to take notes, so you can compare it to other plans.
• Think about your current and ongoing needs. Do you have a chronic condition managed by an established care team? If so, are your providers in network on both plans? Are there limitations on coverage? You’ll want to be able to answer all these questions confidently — and understand the potential costs involved.
• Anticipate future needs. For example, if you plan to start a family, does your health insurance cover fertility treatments, maternity care and pediatrics?
• Look at how often you reach out-of-pocket maximums. If a family member has high medical needs, paying for double coverage may be the cheaper option.
• Consider the financial impact of a worst-case scenario. What might happen if you or a family member has an unexpected critical illness? Do you have coverage in place?

How can my spouse add me to their health insurance?

If you have employer-based insurance, work with your company’s human resources department. For ACA or private insurance plans, you can explore health insurance plans now.

I lost my job-based health insurance. What other options besides joining my spouse’s plan do I have to get health insurance?

While losing health insurance is a qualifying life event, you may not want to sign up for your spouse’s health plan. For example, the premium to add you may be too expensive. Other options may include:

• COBRA, which stands for the Consolidated Omnibus Budget Reconciliation Act, is a law that allows you to continue your employer-based health insurance for 18 to 36 months after you lose coverage (depending on circumstances). COBRA can be expensive, though, because you typically pay the full premium, including any amount that your former employer previously covered.
• If you belong to a professional association or other membership group, they may offer a group plan to their members.
• Short-term medical plans provide private health coverage for a limited amount of time (coverage term is 3 months + 1 month extension for a maximum coverage period of no more than 4 months) when you don’t have other coverage. Keep in mind that these plans are not comprehensive health insurance and may not cover certain medical expenses. Preexisting conditions also apply, which means if you currently have symptoms or have seen a doctor for something, it won’t be covered under the plan. Short-term medical plans do not meet all federal requirements to qualify as Minimum Essential Coverage for health insurance under the ACA.
• You may be able to purchase your own ACA plan. With an SEP, you’ll have an opportunity to sign up for coverage, if that’s the route you want to go with.

COBRA can be expensive — especially if you lose your job. Find out why short-term medical insurance could be an affordable alternative. Call a licensed insurance agent at 1-844-211-7730 for more information.

Compliance code:
51749-X-1124