Just Married? Let’s Talk Health Insurance
Written by: Andrew Hall
Getting married is considered a Qualifying Life Event (QLE) and allows you and your spouse to make health plan changes for 60 days following your wedding.
Before determining if you and your spouse should be on the same health plan, consider your options and the implications.
Think about your individual health care needs and how the plans available to you accommodate them.
Talk openly about if and when you will expand your family.
Look into employer-sponsored health plans if they are available to you or your spouse.
Okay, so maybe that wasn’t on any of the cards you received on your big day. But did you know that getting married is considered a Qualifying Life Event (QLE)? [i]
A QLE means you and your spouse have a unique opportunity to enroll in health coverage outside of Open Enrollment. You and your spouse have 60 days from your wedding day to decide if you want to purchase joint health insurance (a “family plan”) or rather stay on two different plans.
Find a local Medicare plan that fits your needs
Before automatically assuming that the old marriage adage “what’s mine is yours, “ consider all factors before making a purchasing decision.
Here’s a quick breakdown of your options:
- You are purchasing two individual health insurance plans from a marketplace, one for each of you.
- You are purchasing one family health insurance plan from a marketplace, one that will cover both of you.
- If applicable, remaining on two separate existing employer-sponsored health plans.
- Adding one spouse to the other spouse’s existing employer-sponsored health plan, one that will cover both of you. (Note: employer-sponsored health plans require QLE changes within 30 days of the QLE.)
Chat about your health histories and health care needs
Maybe you didn’t exactly talk about your detailed health histories while you were dating and engaged —but now is the time to lay it all on the table. Knowing about family histories, certain risk factors, and both current and future health care needs will help you and your spouse make a sound decision on how to move forward.
If one of you is generally healthy and the other may require higher levels of medical care, it may make more sense financially to be on two separate health insurance plans.
Consider asking these questions to guide your conversation:
- Does either of us take regular prescription medications?
- Does either of us require regular office visits to specialists? Think psychiatrist, endocrinologist, allergist, physical therapists, etc.
- Will either of us require any medical procedures in the foreseeable future?
- Do either of us smoke or participate in any other behaviors that could contribute to health issues in the future?
Determining your individual healthcare needs is a crucial step to take before deciding how to approach health insurance as a married couple.
Don’t shy away from the baby conversation.
Has it happened yet? Has your great aunt started dropping hints about it being time to expand your family? We know, we know — you haven’t even unpacked from the honeymoon yet. But here’s the truth: Knowing if and when you and your spouse are planning on adding kids to the equation will influence your health insurance decision.
Suppose you’re planning on growing your family (by birth or adoption) immediately. In that case, it makes sense to consider a plan’s coverage for certain things like maternity and newborn care, inpatient hospital stays, and pediatric visits.
Look into your employer-sponsored coverage
One or both of you may have access to a group health plan through an employer. Employer-sponsored coverage can be an affordable option for families who do not need to customize their coverage to account for specific healthcare needs.
If you or your spouse have employer-sponsored health insurance, you may add your spouse but will need to do so within 30 days of your wedding date.
Are you eligible for cost-saving Medicare subsidies?
If you or your spouse have employer-sponsored insurance, the other is not required to use the group plan. You can use the Marketplace to shop for an individual plan that covers you while the other’s insurance works alongside.
It’s probably best to let your plan carrier or office benefit manager know about the marriage. Especially for first marriages, it’s likely that you won’t add a name and switch from individual to family coverage with the click of a button. If you’ve already had family coverage because of a dependant, you may have an easier time adding to your family coverage.