Can Married Couples Have Separate Health Insurance? What You Should Know

Health
Written By Shauna Gleason

 The Gist

  • Many factors may go into whether couples should be on the same plan, including affordability and regular medical expenses. 

  • Getting married is a qualifying life event, meaning you can modify your coverage outside of open enrollment period (OEP).

  • Adding your spouse to your plan may impact your premiums, deductibles, and other health care costs.

In This Article

In Short

Are you hearing wedding bells? If you and that lucky someone are planning to say “I do” this year, you may have some questions about your health insurance coverage and whether or not it makes sense to add your spouse or life partner to your plan (or for them to add you to theirs). 

While it may seem relatively straightforward — after all, a majority of couples decide to consolidate their coverage under a single plan — there are a number of situations where it might make sense for a married pair to maintain separate policies. Wedding planning can be stressful enough, and while Stride can’t help you hire a caterer, we can make the “finding answers to your healthcare questions” part a little easier!

When Does It Make Sense for a Couple to Be on the Same Plan?

Many married couples will simply choose the easiest health insurance plan option available and will miss out on important distinctions that can impact the overall affordability of your health care throughout the year (and you might want those savings if you were thinking wedding band instead of DJ!). 

But in reality, there are many factors that go into deciding if you should add your spouse or life partner to your health insurance plan. These include:

  • Affordability: One partner’s plan might become unaffordable when their significant other is added or vice versa.

  • Planned medical expenses: A couple may assess their annual medical expenses (for instance, regular specialist visits) and choose to remain on separate plans that better suit their individual needs.

  • Access to out-of-network care: If, for example, one partner needs to travel more than the other, they may want to make sure their plan is going to give them the best coverage possible when they are away from home.

Are Employers Required to Offer Health Coverage for Spouses and Life Partners?

Under the American Care Act, which was signed into law in 2010, employers with more than 50 full-time employees are required to offer coverage to employees and their eligible dependents (like your kids). Despite this, there is currently no requirement that employers provide coverage to spouses and life partners. Many employers do offer health coverage to partners, but this often raises the cost of your insurance and/or deductible amounts.

We recommend using Stride to see all of the options available to you in your state of residence or due to your income level or employment type. You may discover situations where it can be more cost-effective to have separate plans — even if you’re married and sharing other household expenses. 

Should I Add My Partner to My Insurance Before or After the Wedding?

Check with your benefits department, because some companies offer life partner benefits to couples that have been living together for a set amount of time. You may need to provide documents proving that you live together. If this is not the case and you cannot add your partner until after you are legally married, just be sure to add your spouse to your plan within 60 days of your wedding.

Getting married is considered a qualifying life event, which means you can make changes to your health insurance policy outside of the open enrollment period (OEP). If you miss that 60-day window, you will likely have to wait until your company’s OEP before making any changes to your coverage. OEPs vary by company and state, so if you’re confused, check with your benefits department.

Your benefits officer or HR department should be able to help you sort this out, but don’t wait to get the process started. Any lapse in coverage for you or your spouse could mean costly medical bills or unexpected out-of-pocket expenses. 

Is a Wedding a Qualifying Life Event?

Getting married is a qualifying life event that allows you to make changes to your health insurance policy outside of OEP. 

Other qualifying life events include:

  • Births

  • Deaths

  • Moving to a new zip code, state, or country

  • Major changes in household income

  • Losing employer-offered coverage

Is It a Good Idea to Add My Spouse to My Health Insurance?

Take a break from wedding planning (we know, we know!) and set aside some time to explore all of the policies and coverages offered by your employers’ options. Some things to consider are:

  1. Coverage tier levels: Discuss your health care needs with your partner to make sure you have an understanding of what sort of regular medical expenses might arise. For instance, you might have a set number of regular specialist visits (physical therapy, mental health counseling, etc.) that would make it beneficial to be on a higher-premium, lower-deductible plan like the Gold or Platinum plans, while your spouse might have fewer expected expenses and therefore could get by on a lower-premium, higher-deductible plan like the Silver or Bronze offerings.
    Depending on your state of residence, income, or other factors, you could save hundreds (or even thousands!) of dollars a year with some savvy selections.

  2. Deductibles: Different coverage tier levels typically are reflected in the plan’s “deductible.” Put simply, this is the amount you’ll be expected to pay out of pocket before your insurance company starts kicking in a higher percentage to cover certain medical expenses. In 2023, the average medical deductible in plans with combined medical and prescription drug deductibles is as follows:

  • Bronze: $7,481

  • Silver: $4,890

  • Gold: $1,650

  • Platinum: $45

You’ll want to be aware of what your deductible is and keep track of your out-of-pocket expenses throughout the year so you can maximize the value of your policy.

  1.  Premiums: As we mentioned above, employers with more than 50 employees are required to offer coverage to workers’ dependents, but not to their spouses. Occasionally, the non-mandatory coverage provided comes with considerable additional cost to your regular premiums. It is important to look at all the options and see how it will impact your budgeting and day-to-day spending before adding your spouse or life partner to your plan.

  2.  Health Savings Accounts: Some plans will offer you the option of putting pre-tax earnings aside in a Health Savings Account (HSA) to help pay certain medical expenses. In 2023, the annual limit for HSA contribution is $7,750 for a family and $3,850 for an individual. If you have a joint HSA, the policyholder’s name will be the one associated with the HSA, even if you are both separately paying into it. Once again, this could come into consideration if one partner has more regular, scheduled, or expected medical expenses than the other. 

Can You and Your Spouse or Life Partner Have Separate Health Insurance Plans?

Of course you can! As mentioned above, there may even be occasions where having separate insurance policies from your spouse or life partner will save you money in the long term. We recommend using our online tool and making sure you have all of the available information about your employers’ health care benefit offerings. 

Don’t be afraid to dig around until you find the plan that is right for you. Depending on your state of residence, income level, employment type, and other factors, there might be plan options available that make a big difference when budgeting. Because Stride is an approved partner of HealthCare.gov, that means you’ll be able to compare and contrast plans from all the major providers.

Whether you choose to add your spouse or life partner to your insurance plan or keep separate policies, it’s important to know all the options, and Stride is here to help. 

What’s Next?

So you’re getting married — congrats! Remember that you have 60 days from the wedding to add your partner to your health insurance policy, if you choose to do so. Your nuptials are what’s known in the industry as a QLE,  meaning you can make changes outside of your company’s OEP.

To decide whether or not you should add your spouse to your insurance, use our online tool to compare your employers’ plans as well as options from your state-level exchanges. Although most couples choose to take the path of least resistance and put the whole family on a single policy, there may be a number of factors where you could save a considerable amount of money with separate plans — and that means more cash for the honeymoon fund!

Shauna Gleason