As two individuals come together in the bond of marriage, they need to make many decisions that will shape the course of their lives together. One thing that many new couples take for granted has to do with insurance coverage, and more specifically — health insurance. If you ever wondered, “Do I have to cover my spouse on my health insurance?” you’re at the right place.
While it’s true that many married couples opt for combining their health insurance coverage, that’s not always the best decision.
Regardless of which option newlyweds choose, they need to make a decision quickly because of something known as a special enrollment period, which couples qualify for after they experience a qualifying life event (e.g., getting married). You will only have 60 days to either alter an existing healthcare plan or buy a new one, and the countdown starts from the moment you exchange your “I dos.”
Now, let’s have all your questions answered regarding health insurance for a spouse and explain all possible health insurance options and their pros and cons in this article.
Do Married Couples Have to Be On the Same Health Insurance?
According to spouse health insurance laws 2020, couples are no longer required to be on the same health insurance. In other words, if you both already have individual health insurance plans that you are happy with, there is no good reason to get rid of that coverage.
That being said, spouses can share the same plan, which can be a more cost-effective option in some circumstances. Since it depends on each individual case, newlywed couples need to factor in all of the pros and cons of being in a joint policy or having separate individual health insurance coverage plans.
How Does Spouse Health Insurance Work?
Once two individuals get married, they will be eligible to join each other’s employer-sponsored health insurance. If a spouse has alternative health care coverage, an employee will have to pay a spousal surcharge, an additional fee or premium, for their policy.
Should I Add My Spouse to My Health Insurance?
In most cases, you can add your spouse to your health insurance plan. However, this needs to be done 60 days after your marriage date.
The good news is that if you and your partner are both in good health, you can end up saving money when combining your health insurance coverage.
However, if one spouse has been diagnosed with a chronic illness, you can opt for an insurance plan with a lowered deductible for one partner and a higher deductible and lower cost plan for the other one. In this case, two separate policies will be a more economical solution.
Who Counts as Dependent? Can You Remove Them at Any Time?
Usually, your spouse and children count as dependents on your health insurance plan. And the best part is that you can remove them at any time.
Can I Cancel My Health Insurance Plan Without a Qualifying Event?
Yes, you can cancel your individual health insurance plan without a qualifying life event. However, you are not allowed to cancel health coverage provided by the employer at any time. It would require a qualifying event.
What Is a Qualifying Event to Remove a Dependent From Your Health Insurance Policy?
Significant events in one’s life, such as a marriage, divorce, childbirth, adopting a child, etc., are considered qualifying life events in the eyes of insurance providers.
In addition, a dependent may no longer be eligible for your insurance policy for many reasons, such as marriage, full independence, and age. Other conditions include the death of a dependent or spouse.
Choosing the Right Plan When Both Spouses Have Employer-Sponsored Health Insurance
Picking the right health insurance plan once you get married is an important step that should not be taken for granted.
When it comes to employer-sponsored health insurance coverage, it’s important to note that your employer shares the costs of premiums with you. Your employer is the one that selects the plan options. Additionally, premium payments from your employer are not taxed at the federal level, and the portion of premiums you pay is usually excluded from taxable income.
However, choosing the right health insurance plan when both spouses already have employer-sponsored health insurance can be tricky. This is why it's always best to explore both options, spousal coverage and dual coverage.
Spousal Carve-Outs
Spousal carve-outs are a type of health insurance plan businesses use to keep healthcare expenses down by limiting coverage for an employee’s spouse. The “working spouse rule” is another name for this sort of plan.
Dual Coverage
When it comes to dual coverage options, you each enroll in coverage via your work and cover each other and the entire family with your plan. In other words, all members of the family will have health insurance coverage from not one but two insurance plans. This is referred to as dual coverage. Maintaining two policies will be more expensive, but it may give additional coverage in some circumstances.
To figure out what’s best for your family, compare these two coverages and total expenses with both plans.
Affordable Care Act
Under the Affordable Care Act, big businesses must provide affordable coverage to their full-time employees or else risk financial penalties. If one family member owns this affordable plan, it may prohibit other family members from enrolling into marketplace plans with lower premiums and cost-sharing. It’s known as a “family glitch.”
Government-Sponsored Health Insurance
Government-funded healthcare provides access to medical treatment to all uninsured people. Decreased government healthcare expenses make insurance coverage more affordable for millions of people and companies.
Health Savings Accounts
HSA Contribution 2022
According to the IRS Revenue Procedure 2021-25, individuals will be able to contribute $3,650 for individual HSA coverage in 2022, compared to $3,600 in 2021. As for family coverage, the amount will reach $7,300, a $100 increase from 2021. If you’re over 55 years old, you can sock away an additional $1,000 a year.
Only individuals can qualify for Health Savings Accounts (HSAs). As a result, combined HSAs between couples are not permissible. If both partners qualify for HSA, they must each open their own accounts.
Can I Add My Spouse to My HSA Account?
Yes, you can because the HSA belongs to an individual and not an employer, making anybody eligible. You can create and contribute to an HSA if you are covered by a High Deductible Health Plan (HDHP).
Do Both Spouse’s Plans Cover the Same Doctors? In-Network vs. Out-Of-Network
After answering the question, “Do I have to cover my spouse on my health insurance?” it’s time to get familiar with the difference between in-network and out-of-network options regarding insurance policies.
In-network providers have an agreement with your insurer to offer negotiated rates to customers. In contrast, out-of-network providers charge full price, as they don’t have a contract with your insurance company.
A provider network is part of any health insurance plan. This is a list of doctors, pharmacies, hospitals, and other healthcare providers that the insurance company contracts with to provide medical treatment.
You’ll pay less for your portion of medical costs if you see a doctor who is a part of the network — an in-network provider. You’ll pay extra if you go to an out-of-network provider.
So, if there is a provider you like, you should contact your insurance company to find out whether it’s in the provider network list of your or your spouse’s health insurance plan.
Health Insurance and the Divorce Process
Regarding health insurance after divorce, a judgment for legal separation is treated the same way as a judgment for dissolution of marriage by most health insurance policies. This implies that if you are subject to a judgment of judicial separation, you are no longer considered a dependent of your spouse or partner for health insurance purposes.
Who Pays for Health Insurance After Divorce?
Following a divorce, each spouse is usually responsible for their own medical insurance coverage. This also means that if you were covered by your spouse’s employer-provided insurance plan, it would no longer apply to you once the divorce has been finalized.
Can a Separated Spouse Stay on Health Insurance?
Your partner or spouse could let you remain on their insurance plan. But usually, after the divorce is finalized, the insurance provider has the authority to drop you.
In some instances, though, you may be eligible to remain dependent on your partner’s health care coverage. But this depends on whether or not your spouse has a government plan and if you are subject to a judgment of legal separation. It’s crucial to confirm this with the insurance provider directly to ensure you get all the details right.
It’s also important to note that if you live in a state that considers separation the same as divorce, you may lose your spouse’s health insurance coverage in the same way as if you were divorced.
Standard Family Law Restraining Orders
Standard family law restraining orders take effect after you file or receive service of the Summons for Dissolution of Marriage (form FL-110), which prevent you from changing or canceling any of the beneficiaries for any insurance coverage.
This law also applies to life, health, disability, car, and other insurance policies held for the benefit of your minor children or either party. As a result, you can’t drop your spouse from your health insurance while your divorce is in progress. If you remove your spouse from your health insurance without a court order, you’ll almost surely face legal troubles.
As much as you want to separate from your soon-to-be ex-spouse, you don't want to risk damaging your case by making a reckless decision. Your income, including your share of the community property and separate property, may be held accountable for 100% of your spouse’s uninsured medical costs.
COBRA Coverage
Even though, according to the Consolidated Omnibus Budget Reconciliation Act (COBRA), some individuals are allowed to remain on their spouse’s health insurance policy for a given period of time, it doesn’t last long. In fact, you will be responsible for paying all of the monthly payments without any help from your employer. It’s crucial to understand how much those rates cost, so you can plan your budget once you’ve divorced.
In Conclusion
So, do I have to cover my spouse on my health insurance?
Once you get married, you are eligible to join one another’s employer-sponsored health insurance. In addition, in certain scenarios, separate health insurance plans can be a better financial solution.
You may wish to keep your health insurance plan status as “single” while checking the “married” box on the form. It may seem paradoxical, given that family health plans are commonly considered to save money. However, this isn’t always the case.
It’s important for newly married couples to do their homework and educate themselves on the different health insurance options and benefits to get the best bang for their buck.
