Choosing the Right Health Insurance When Both Spouses Work

July 5, 2019

If you and your spouse both work, you may have trouble choosing the right health insurance. Generally, you have three options. You can each have your own policy through your respective employers; you can both join one policy, or you can both join both policies.

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Keep reading to see how these options work.

Choosing Your Own Policies

Many couples keep the insurance they had before getting married even after they say ‘I do.’ Even though marriage is a ‘qualifying event,’ enabling you and your spouse to choose the same policy, there’s no obligation to do so.

If you like the policy you have and your spouse likes his or her policy, there’s no reason to change. There may be slight inconveniences, such as being unable to see the same doctors, depending on the requirements of each plan, but most couples get through it. Of course, you must both pay premiums on your separate policies, which can get confusing, but if your employer automatically deducts the premiums from your paycheck, you don’t have to worry about it.

Joining the Same Policy

If together you and your spouse decide to jump on the same insurance policy, you must choose between the two policies. Before you choose a policy, consider the following:

  • Cost of the premiums
  • The deductible for each policy
  • The co-pays for each policy
  • The co-insurance for each policy

Looking at the big picture can help you choose which option works best. For example, if one spouse’s policy has a high deductible, but low premium and the other spouse’s policy has a low deductible but high premium, you should decide which is more important. Would you rather have more money in your pocket each month (lower premiums) or require less money out-of-pocket when you see doctors (lower deductible)?

Joining Both Policies

You may also opt to join both policies. You’d pay double the premiums, but have the advantage of extra coverage. Don’t mistake this for ‘double coverage, though.’ The insurance companies require ‘coordination of benefits.’ The insurance from your employer is your ‘primary policy’ and your spouse’s primary policy is the one from his employer. The secondary insurance is the policy from the spouse.

Here’s a simplified version of how it works:

You fall and break your leg. You go to the ER and file a claim with your primary insurance. You have a $500 deductible. You must meet this deductible on your primary insurance first. After the $500, your insurance covers 80% of the cost of the ER. You are on the hook for the remaining 20% plus the $500.

You file a claim with your secondary insurance after your primary insurance. The secondary insurance will wait to see what the primary insurance pays. The secondary insurance then applies the insurance benefits to the remaining balance (the 20% of the total bill minus $500). But, you must meet the deductible for the secondary insurance as well. If there is a $500 deductible on the secondary insurance too, you may see little benefit from the secondary insurance, if any.

While it sounds great to have two insurance policies, you should look at the total cost out of your pocket before deciding. If both have high deductibles and/or different networks of doctors/hospitals, it may not make sense to pay premiums for both policies.

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Switching to Your Spouse’s Health Insurance

Once you decide which policy you and your spouse want, you must sign up for the respective policy. Typically, you must wait for open enrollment when adding dependents or changing policies, but if you do it right when you get married, you don’t have to wait. Insurance companies allow you to make changes during what they call ‘qualifying life events,’ and getting married is one such event. Having a baby is another qualifying life event.

Typically, insurance companies give you 60 days after the qualifying event to make changes to your insurance policy. If you don’t switch your spouse to your policy or vice versa, within that time, you must wait until your company’s open enrollment period. Your HR department can tell you when open enrollment occurs for your company.

Employers Don’t Have to Offer Health Insurance to Spouses

The Affordable Care Act (the insurance law in the US) requires employers with 50 or more employees to offer health insurance to its employees. The law doesn’t require employers to offer insurance to spouses, though. Employers can choose to do so, but the law doesn’t mandate it.

Pay close attention to the financial help your employer provides as well. Just because they pay 100% of the employee’s premium, doesn’t mean they will pay any of the premium for a spouse if they offer spousal coverage. Ask specific questions regarding the cost so that you can make the most financially plausible choice.

If you and your spouse work lay out all of your options for health insurance. Consider how much you both use insurance as well. If you see doctors often, you may want a plan with a lower deductible. If neither of you uses your insurance much, but want/need it in place for emergency situations (everyone should), then you may opt for a higher deductible, keeping more money in your pocket on a monthly basis.

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