Are you recently married or about to get hitched? Congratulations! Unfortunately, it’s not all cake and champagne once the honeymoon suitcases are put away and the thank you notes are sent.
There will be some serious financial decisions to make with your new husband or wife:
- Will you open a joint checking account or maintain separate finances?
- How and where will you save for retirement, a home or travel?
- Will you get life insurance?
- Should you bundle your auto and home or renter’s insurance under one policy?
- And what will you do for health insurance as a married couple?
If you are healthy, on a tight budget, and without job-based health insurance benefits, it may be tempting to opt out of health insurance coverage for a little while to try to save money.
Unfortunately, circumstances can change in an instant and healthcare in the U.S. is expensive. For example:
- It costs as much as $7,500 to fix a broken leg[0]
- The average 3-day hospital stay is around $30,000.[1]
Health insurance benefits can help lower what you pay out of pocket in these situations. And fortunately for newlyweds who do not have access to health insurance benefits through an employer, there are several options for obtaining health insurance coverage. We’ll cover six of them:
- Special enrollment in ACA-qualifying major medical insurance (within 60 days of your marriage)
- Your spouse’s job-based coverage (within 30 days of your marriage)
- A parent’s health insurance plan (if you’re under 26)
- Medicaid (if you qualify)
- Catastrophic health plans (within 60 days of your marriage, if you qualify)
- Short term health insurance (not ACA-qualifying health coverage, you must qualify to enroll)
Should You Share a Health Insurance Plan with Your Spouse?
Before we get into the different health insurance options available to you, let’s take a step back and consider if you and your husband or wife should share the same health plan at all.
In some instances, it may make more sense financially to be on separate policies. It all comes down to what your out-of-pocket exposure is as a family unit, what your healthcare needs are as individuals and how the math works out as a result.[2]
The maximum out-of-pocket costs that you are responsible for trend up pretty consistently every year. And while your cost-sharing amount ultimately depends on your specific plan, you are generally responsible for medical costs you incur until you reach your annual deductible.
After that, you typically have to continue to pay something out of pocket (in the form of coinsurance) until you reach your policy’s annual maximum.
Take a closer look at coinsurance, copay, deductibles and annual limits.
ACA Annual Out-of-Pocket Maximum Limits 2016 to 2020
| Individual | Family | |
| 2016 | $6,850[3] | $13,700[4] |
| 2017 | $7,150[5] | $14,300[6] |
| 2018 | $7,350[7] | $14,700[8] |
| 2019 | $7,900[9] | $15,800[10] |
| 2020 | $8,200[11] | $16,400[12] |
It is worth comparing the out-of-pocket maximum and deductibles on both individual (self-only) health insurance policies that you and your spouse are considering and on a family policy that would cover you both.
You may find that your total out-of-pocket costs could be less if you get two separate policies. It also gives you the ability to select a policy that best supports your individual healthcare needs if they vary widely between the two of you.
For example, if you have a pre-existing condition that requires more health services (testing, treatment and doctor’s appointments) you may benefit from a policy with a lower-deductible and annual maximum paired with a higher-premium since you’ll reach your deductible and annual maximum amounts sooner and be able to utilize more of your health benefits for the year.
If your spouse is healthy and requires very minimal healthcare, they may opt for a policy with a higher deductible and lower monthly premium, assuming they won’t meet their deductible for the year and trying to limit their monthly costs in the meantime.
However, if you chose to be covered on the same policy with double the annual maximum (see the table above) or deductible, it would take you, together, much longer to reach those amounts for the year seeing as how your spouse uses very minimal services. As a family, you would be paying a larger portion of your medical bills until your benefits kicked in.
How to evaluate your healthcare needs so you can obtain enough coverage.
Health Insurance Options for Married Couples
Let’s look at six health insurance options to consider if you’re married, particularly if you’re a newlywed.
ACA-qualifying major medical health insurance
Getting married is one of the life events that makes you eligible to buy health insurance outside of the annual health insurance open enrollment period.[13] You and your spouse qualify for a special enrollment period that lasts 60 days from the date you say “I do.”
You can enroll in a family plan that covers both of you on one policy, or two separate policies if that better meets your needs.
Major medical insurance is:
- Comprehensive coverage that includes essential health benefits, including preventive and wellness services
- Guaranteed issue, which means you cannot be denied coverage due to a pre-existing condition or health history
- Considered ACA-qualifying minimum essential coverage.
You can buy major medical health insurance plans through a state-based or federally facilitated health insurance exchange, as well as from an agent or health insurance company in the private marketplace.
Keep in mind that if you qualify for a premium tax credit and wish to take advantage of the savings, you must purchase health insurance coverage from a state-based or federally facilitated health insurance exchange and apply for the subsidy. What is ACA-qualifying major medical insurance and do you need it?
See if You Qualify for a Subsidy Now
Your spouse’s job-based health insurance coverage
If your spouse has health insurance coverage through his or her employer, you may be eligible for their workplace plan. When considering joining your spouse on their employer’s group plan, you should determine how that impacts the amount that’s deducted from their paycheck each pay period for premium as well as the increase in deductible.
Again, depending on the type of plan your spouse has, it may make more sense financially for you to obtain a separate, private major medical plan if it results in higher out-of-pocket costs for you to join them on their group policy.
Investigate this option promptly because job-based special enrollment periods may last as few as 30 days. Your spouse should contact his or her human resources department or benefits enrollment specialist for details.
If your spouse’s employer plan has a high deductible, there are some things you can do to help with costs, particularly medical gap insurance.
Get a Short Term Health Insurance Quote
A parent’s health insurance plan
This option only applies if you are younger than age 26. Under the Affordable Care Act, you may be covered by a parent’s health insurance plan until your 26th birthday.[14]
In fact, this can be a very convenient option especially if you’re already covered on a parent’s plan. It may make sense for you, your new spouse, or both of you to remain on your parents’ plans until you have to obtain your own coverage or have benefits through work.
You may be married. You may have access to your spouse’s health insurance plan. You may even have access to major medical health insurance through your own workplace. It doesn’t matter; you can maintain health insurance coverage through a parent.
This applies to a parent’s job-based health insurance plan as well as health insurance plans purchased through state and federal exchanges and in the private marketplace.
Medicaid
Under the ACA, Medicaid eligibility was extended to millions of individuals with incomes at or below 138% of the poverty level. That means that an individual with an annual income of $17,236 in 2019 may qualify.[15]
You can enroll in Medicaid anytime during the year – it is not subject to the 60-day special enrollment period.[16] Could you be eligible?
Not all states participated in Medicaid expansion. As of March 2019, 14 states have still not expanded their programs.[17]
Find out if Medicaid has been expanded in your state.
Get information on how to apply for Medicaid.
Catastrophic health plans
If you’re under 30 or you qualify for a hardship exemption you may be able to enroll in a Catastrophic health plan.[18] Catastrophic health plans are subject to the 60-day special enrollment period.
Catastrophic health plans are ACA-qualifying major medical coverage, however, these plans are designed to help with the out-of-pocket costs associated with unexpected illnesses or accidents and as such, there are a few key differences between Catastrophic coverage and traditional major medical plans (i.e., bronze, silver, gold and platinum plans).[19]
Catastrophic plans:[20]
- Cover essential health benefits
- Cover certain preventive services at no additional cost
- Cover three primary care visits per year prior to meeting your annual deductible
- Are not eligible for premium tax credits
- Have high deductibles: for 2019, the deductible for all Catastrophic health plans is $7,900. However, after you’ve paid that amount, the insurance company pays for all covered services.
- Do not qualify for health savings accounts (HSAs).[21]
Catastrophic plans are available both on and off the ACA exchange, but hardship exemptions for those over 30 years old must be obtained from the exchange. If you’re eligible for a Catastrophic plan, you will see that listed in your results along with bronze, silver, gold and platinum plan options. If you’re not eligible, you won’t see it as an option.[22]
Did you know there are supplemental health insurance policies available to help you pay for your major medical deductible? Get help with a high deductible ACA health plan. Learn about Gap medical insurance.
Get a Gap Health Insurance Quote
It just takes a couple of minutes to quote and enroll online in a Gap policy.
Short term medical insurance
If none of the options described so far are available to you or if you missed your special enrollment period, there is an alternative to going uninsured and exposing yourself to potentially high out-of-pocket costs.
You may qualify for temporary health insurance coverage, known as short term medical insurance, for between 30 and 364 days depending on your state.
These insurance plans are not considered minimum essential health coverage under the Affordable Care Act (ACA). That means they aren’t guaranteed issue and don’t include coverage for the essential health benefits as required of ACA-qualifying major medical plans.
They are policies designed to only cover hospitalization due to unexpected illness and injury.
Some of the advantages of short term health plans are that they:
- Have lower monthly premiums because they provide less coverage than major medical plans – short term medical premiums can be one third the cost of major medical premiums[23]
- Are flexible with a range of different deductible and premium amounts to fit different budgets and needs – your cost depends on the level of benefits you select
- Are not subject to the ACA’s open enrollment period, you can apply anytime
- Can be obtained quickly – you can begin coverage the day after your application is accepted.
Within minutes, you can apply for short term medical insurance online and enroll in coverage the next day if you qualify.
Get a Short Term Insurance Quote
Your Health Insurance Rights as a Same-Sex Couple
On June 26, 2015, a Supreme Court ruling (Obergefell v. Hodges) declared same-sex marriage a right in all 50 states.[24]
That means that married same-sex couples have access to the same legal rights and benefits as any married couple, and their marriages are recognized on birth certificates, death certificates and other official documents.
Many tribal nations do not address the recognition of marriage, or other relationships, between same sex-couples. And while historically most tribal nations accepted (if not revered) LGBTQ members, in present day, of the 567 federally recognized tribes in the US, only 35 are believed to officially recognize same-sex marriage (as of 2018).[26] And a few tribes expressly prohibit marriage between same-sex couples.[27]
If you have questions about the laws of a particular tribe, check with that tribal government.
The 2015 Supreme Court ruling had the following health insurance implications for same-sex couples:
- A health insurance company that offers health insurance to opposite-sex spouses must also offer health insurance to you.[28]
- You are eligible for the premium tax credits from the ACA Marketplace the same as opposite-sex couples.[29]
- All states must recognize your marriage when determining whether or not you meet eligibility requirements for Medicaid or CHIP.[30]
- You may now qualify for Medicare coverage based on your spouse’s work history.[31]
- You may obtain spousal benefits for your partner if you are a federal employee, federal contractor, member of the military, veteran, or state employee.[32]
Regardless of the 2015 SCOTUS ruling, employers are still not explicitly required to extend group health insurance benefits to same-sex spouses, however, they could be found in violation of Civil Rights law if they fail to do so.[33]
Even so, access to employer-provided benefits for same-sex spouses has improved from 2016 to 2018.[34]
- 2016, 43% of firms offering spousal benefits extended benefits to same-sex spouses.
- 2017, 57% extended benefits to same-sex spouses.
- 2018, 63% extended benefits to same-sex spouses.
Legal Disclaimer: The materials available at this web site are for informational purposes only and not for the purpose of providing legal or tax advice. You should contact your attorney or tax professional to obtain advice with respect to any particular issue or problem.
Your Health Insurance Options as a Same-Sex Couple
The same options outlined earlier in the blog post apply to you.
However, if you missed your special enrollment period or you’re having difficulty or experiencing a delay in securing coverage through your spouse’s employer, an alternative option like short term health insurance could help provide some coverage until you’re able to secure major medical benefits.
Get a Short Term Health Insurance Quote
Many supplemental health plans like dental insurance and hospital indemnity insurance also offer coverage to same-sex married couples.
Summary + Next Steps
We’ve covered a lot of options today. The key points to keep in mind are that whether or not you and your spouse obtain a policy together depends on your unique healthcare needs, employment status and finances.
There’s not a one-size-fits all recommendation and what works for you as a newlywed may not work for you next year. Going forward, it will be important to assess your situation each year and make changes in your coverage as necessary during annual open enrollment.
For now, you can consider:
- Special enrollment in ACA-qualifying major medical insurance (within 60 days of the qualifying life event)
- Your spouse’s job-based coverage (within 30 days of your qualifying life event)
- A parent’s health insurance plan (if you’re under 26)
- Medicaid (if you qualify)
- Catastrophic health plans (if you qualify)
- Short term health insurance (not ACA-qualifying health coverage, you must qualify to enroll)
If you have questions and want to speak with an insurance agent, call (888) 855-6837 during business hours.
