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What you need to know about adding your spouse to your health plan

You share everything with your significant other — but can you share your health plan too? Here’s what you need to know.

You share many things with your spouse — a home, a family and love. You probably share some less romantic things as well, such as bank accounts, loans and bills. And you have the option to share a health insurance plan with them too.

If you plan to make changes to your health coverage after you get married, you’ll most likely have a limited time to do so. Or there may be other situations that come up later where you find that you need to add your spouse to your insurance. For example, if they lose their job and their health insurance.

Whatever your situation, you may have questions about how the whole process works. How can you add your spouse to your health plan? Here are answers to some of your most pressing questions, to make it as easy as possible.

A licensed insurance agent can help you find a health plan that meets you and your family’s needs. Call today at 1-800-273-8115, or explore for more information.

When can I add my spouse to my healthcare plan?

If you have a healthcare plan through your employer or through the Affordable Care Act (ACA), you have some options. First, you can add your spouse to your healthcare plan during Open Enrollment. That’s a period once a year when you can:

  • Adjust your current plan
  • Cancel your plan
  • Sign up for a new plan
  • Switch plans

When Open Enrollment happens — and how long it lasts — depends on you how you’re covered. If you have employer-sponsored coverage, your employer sets the Open Enrollment dates. If you have an ACA plan, Open Enrollment normally happens between November 1 and January 15.

You may also qualify for a Special Enrollment Period (SEP). There are certain situations, known as qualifying life events, that allow you to make changes to your plan outside of the Open Enrollment Period, explains Michelle Katz, L.P.N. She’s a health advocate based in Washington, D.C.

Marriage is one such qualifying life event. You’ll have a window of time after your wedding date when you and your spouse can make changes to your health plans. One of you might add the other to an existing plan, or you could sign up for a new plan together.

You can also qualify for an SEP if one of you loses your insurance coverage. For example, if your spouse is laid off from a job and loses their employer-sponsored health plan, you can add them to your plan during a SEP. Other qualifying life events include:

  • Changes in income that effect the type of coverage you qualify for
  • Getting divorced
  • Having a baby or adopting a child
  • Moving to a different ZIP code, county or state
  • Someone on your policy dies
  • You become a U.S. citizen
  • You turn 26 and lose your parents’ coverage

SEPs only last for a limited time, usually 30 to 60 days. So, you’ll need to act quickly when a qualifying life event happens. You can contact your employer’s benefits department or call the phone number on your member ID card to find out the next steps. You can also call a licensed insurance agent at 1-800-273-8115 to explore your options, or search for more information.

Can I add a significant other to my plan if we’re not married?

You may not be able to add your long-term significant other to your health plan. But you may be able to if you’re in a domestic partnership, says Katz. Generally, a domestic partnership is a committed relationship between 2 adults who live together. There are more specific rules depending on what state you live in. You usually have to provide documentation to prove your relationship meets all the rules.

However, not all states recognize domestic partnerships, adds Katz. And even if they do, it may still be up to your employer or health plan to decide whether they’ll allow you to add a domestic partner to your plan.

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Is it better for me and my spouse to be on the same plan or have our own plans?

You don’t have to be on the same health plan as your spouse. In fact, there are some situations in which you may be better off on separate plans. Here are some questions to consider:

  • Do you both have access to employer-sponsored health insurance? You may save money if you each have your own plan through your job. “Usually, an employer will cover more of the employee’s premium than the spouse’s,” points out Katz. So, you may pay a higher monthly insurance bill (premium) if you join a spouse’s plan.
  • Who has the better health plan? Monthly insurance bills aren’t the only cost to consider. There may be other financial reasons to be on the same plan. One plan may have a much lower deductible, for example, which may make it more affordable. (A deductible is the amount you must pay before your health plan starts paying.) Your plans may cover different things too. You’ll want to look at your plan’s summary of benefits for all the details.
  • Are your current doctors covered? If your current doctors aren’t in your spouse’s health plan network, you may prefer to keep your own plan. Check the list of providers to see which plans have the best match for both of you, says Adria Gross. She’s CEO and owner of MedWise Insurance Advocacy in Monroe, New York.
  • Who has the more stable job? If you’re relying on an employer-sponsored health plan, you’ll want to consider how stable your jobs are. “Unfortunately, because of this, what many might define as ‘unstable times,’ we’re seeing many jobs are not as secure as originally hoped,” points out Katz. And that can disrupt your health coverage.
  • How much care do you each need? Individual plans have lower deductibles. If one of you has a health condition that requires lots of care, it might make sense for that person to be on their own plan. That way, they’ll have a lower deductible to meet, and their plan may cover a larger portion of their expenses.
  • Do you have children? If you do, it might make sense for you all to be on one family plan. Family plans have a higher deductible and higher out-of-pocket maximum. But the more people on the plan, the faster you’ll likely meet that deductible and even out-of-pocket maximum, says Katz.

    But again, compare the plans carefully. “Your premiums will go up, and in some cases even adding just one child will double it,” she explains. “You want to do the math and figure out which plan will be most cost-effective.”

Can I keep my plan and join my spouse’s plan?

Yes, you can. If you already have health insurance, you can also opt to go on your spouse’s as a form of secondary insurance, says Gross. Your primary insurance will pay its share of your medical costs first. Then the remaining bill goes to your secondary insurance, which may cover part, or even all, of the remaining cost.

“It can be very helpful if you have unexpected medical costs, such as ending up in the hospital,” Gross explains. But since it’s quite expensive to pay 2 insurance bills, you’ll want to take a close look at the policy and decide whether it’s worth it, she advises.

What other options does my spouse have if they lose their coverage?

If you or your spouse ever lose your insurance coverage, joining the other’s health plan isn’t the only option. You can shop for an individual health plan online, or call a licensed insurance agent at 1-800-273-8115 for more information.

If you choose an ACA plan, you may be eligible for subsidies, depending on your household income. That means the government helps cover some of the cost. So, it could be less expensive than joining your spouse’s employer-sponsored plan.

If you lose an employer-sponsored plan, you may be able to keep your coverage through COBRA, which stands for the Consolidated Omnibus Budget Reconciliation Act. It’s a federal law that allows you to stay on your employer’s health plan after you lose or leave a job. The catch is that you have to pay the full price for the plan. Since employers usually pay a large part of your plan’s monthly premium, COBRA is often unaffordable.

If you think you’ll be without coverage just temporarily, you could also consider short-term insurance. You can join a short-term plan at any time and stay on it for as little as a month or as long as 12 months. This type of plan is a good option if you just need something to bridge a gap between insurance plans.

Depending on which state you live in, you might also be able to get TriTerm Medical insurance, underwritten by Golden Rule Insurance Company. As the name implies, this is a 3-year short-term insurance plan. It offers similar coverage to a short-term insurance plan. But you don’t have to reapply for a second or third year-long term. So, it’s a good option if you think you’ll need something for more than a year.

A licensed insurance agent can help you explore any of these insurance options, including the ACA, short-term insurance and TriTerm Medical. Call today at 1-800-273-8115, or explore for more information.


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