Marriage changes your health insurance options. Here's how to make the transition work in your favor.
Congratulations you just got married. Between the honeymoon planning and thank-you cards, there's one task that probably isn't on your radar but should be: figuring out your health insurance. Marriage is a qualifying life event, which means you have a 60-day window to make changes to your health coverage. That window is an opportunity to save money, improve your coverage, or both but only if you know your options.
Getting married opens up several health insurance paths that weren't available to you before:
Join your spouse's employer plan. If one of you has access to employer-sponsored coverage, the other can now be added as a dependent. This is often the simplest option, but "simplest" doesn't always mean "cheapest." Many employers charge significantly more to add a spouse sometimes $300-500+ per month on top of the employee premium.
Add your spouse to your employer plan. The reverse of the above. Compare both employer plans side by side before deciding which one to join. Look at premiums, deductibles, copays, networks, and out-of-pocket maximums for both the employee-only and employee-plus-spouse tiers.
Each keep your own plan. Just because you're married doesn't mean you have to be on the same plan. If you both have good employer coverage, keeping separate plans might actually save money especially if adding a spouse to either plan significantly increases the premium.
Buy individual plans on the marketplace or through an advisor. If neither of you has employer coverage, you'll be shopping on the individual market. Marriage changes your household income calculation, which can affect your subsidy eligibility on the marketplace. It also opens the door to underwritten plans for couples where one or both spouses are healthy.
The math matters more than the convenience. Here's a framework:
Compare the total cost of three scenarios. First, both on Spouse A's plan. Second, both on Spouse B's plan. Third, each on their own separate plan. For each scenario, calculate the total annual cost: (monthly premiums x 12) + expected deductibles + expected copays/coinsurance based on how much healthcare you each typically use.
Check the networks. Does each spouse's current doctors fall within the other's plan network? If switching to one shared plan means one of you has to find new doctors, factor that inconvenience into your decision.
Consider your health profiles. If one spouse is very healthy and the other has moderate medical needs, separate plans might be smarter. The healthy spouse could qualify for a low-cost underwritten plan while the other stays on a comprehensive employer or marketplace plan. Mixing and matching can save hundreds per month.
If either spouse was receiving ACA marketplace subsidies before the marriage, pay close attention. Marriage combines your household income, which can change your subsidy amount sometimes dramatically. Two individuals who each qualified for substantial subsidies might earn too much combined to receive any subsidy at all as a married couple.
This doesn't necessarily mean the marketplace is no longer your best option, but you need to run the numbers with your combined income. An advisor can help you determine whether staying on the marketplace, switching to underwritten coverage, or taking employer coverage makes the most financial sense post-marriage.
If you're planning to start a family in the near future, factor maternity coverage into your decision now. ACA marketplace plans and employer plans are required to cover maternity and newborn care. Underwritten plans may not include maternity coverage which is fine if you don't need it, but important to know if you're planning a pregnancy within the next year or two.
One common strategy: enroll in an underwritten plan now for the lower premiums while you're healthy and not planning a pregnancy, then switch to an ACA plan during open enrollment when you're ready to start a family.
Marriage is a qualifying life event which means it's one of the few times you can change your coverage outside of open enrollment. Don't let the 60-day window pass without evaluating your options.
Getting married is an opportunity to optimize your health insurance, not just merge it. The best approach depends on your combined income, each spouse's health profile, employer plan options, and future family plans. Taking an hour to compare scenarios can save you thousands over the coming year.
Newly married and not sure where to start? Contact Figueroa Family Insurance for a free consultation. We'll run the numbers for every scenario and help you find the coverage strategy that works best for your new family.