Choosing Health Insurance Companies As Married Individuals
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If you’re married and you and your partner have access to health insurance through your workplace, you might struggle to decide between two different health insurance plans during open enrollment.
It’s likely that both you and your spouse have access to different coverage options with a range of monthly premiums. To determine which insurance company offers the right benefits spread, you’ll need to compare your plan options side-by-side.
Here’s everything you need to consider when choosing between separate healthcare insurance options.
In this article
What is health insurance?
Health insurance is a type of insurance coverage that typically pays for medical, surgical, prescription drug, and sometimes dental expenses incurred by the insured. Health insurance can reimburse the insured for expenses incurred from illness or injury or pay the care provider directly. It is often included in employer benefit packages to entice quality employees, with premiums partially covered by the employer but often also deducted from employee paychecks.
The core principle behind health insurance is to spread the risk of financial costs arising from health issues across a wide group. By paying a periodic premium, members of the health insurance scheme can ensure that if they fall ill or require medical treatment, the health insurance provider will cover all or a portion of the medical costs, depending on the insurance policy terms.
There are various types of health insurance plans, including:
- Private health insurance. This is often purchased by individuals or offered by employers. It includes a range of plans such as HMOs (Health Maintenance Organizations), PPOs (Preferred Provider Organizations), and EPOs (Exclusive Provider Organizations), each with varying levels of flexibility and coverage.
- Public/government health insurance. Examples include Medicare, which is available to seniors and some disabled individuals in many countries, and Medicaid, which provides coverage for some low-income people, families, children, pregnant women, the elderly, and people with disabilities in the United States.
- Managed care plans. These plans contract with healthcare providers and medical facilities to care for members at reduced costs. These healthcare providers make up the plan's network.
- High-deductible health plans (HDHPs). Often linked with Health Savings Accounts (HSAs), these plans have higher deductibles but lower premiums. HSAs allow individuals to save money tax-free against medical expenses.
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Health insurance plans typically come with premiums, deductibles, co-payments, and co-insurance:
- Premium. The amount you pay for your health insurance every month.
- Deductible. The amount you pay for covered health care services before your insurance plan starts to pay.
- Co-payment. A fixed amount you pay for a covered health care service, usually when you receive the service.
- Co-insurance. Your share of the costs of a covered health care service is calculated as a percent of the allowed amount for the service. You pay co-insurance plus any deductibles you owe.
Comparing medical insurance plans
Going into your planning session with your medical history in mind is a good idea. When comparing medical plans, you can review past years’ expenses and the number of routine visits you typically take to certain doctors.
Aside from this, here are some factors to consider, including cost-sharing from your insurance company and referral options.
Deductibles
An important consideration is how much you’ll pay out-of-pocket before the insurance coverage kicks in. If you don’t make many trips to health professionals in a year, a high-deductible health plan (HDHP) might suit you well and comes with some benefits, like the ability to save in a health savings account (HSA) plan. You’ll also have lower monthly premiums than you would with a lower-deductible plan.
A health-maintenance organization (HMO) is one type of health coverage with lower monthly premiums, lower deductibles, and fixed copay costs for physician’s office visits. However, you may be limited to a smaller network of healthcare services and providers.
Point-of-service or POS plans may also offer lower monthly premiums in exchange for a more limited network of physicians. Conversely, a POS plan often lacks a deductible, meaning your coinsurance would kick in if you needed out-of-network care.
A preferred provider organization (PPO) offers access to a large network of physicians and often has more covered services. But you’ll likely pay a higher monthly premium and copays in exchange. It’s usually easier to use a PPO out of state than it is an HMO.
If you have a lot of ongoing medical expenses or have a family with unpredictable medical needs, opting for a lower out-of-pocket maximum might save you the most money on out-of-pocket costs. On the flip side, you’ll have a higher monthly premium than you would with an HDHP or PPO.
Copays
Your health care costs will also be impacted by how much you must pay out of pocket in copays at doctor’s offices and hospital visits. Your copays may vary greatly across plans and differ for in-network and out-of-network providers. Some plans may not have copays in certain instances.
You might be fine with a higher copay if you don’t frequent doctor's offices during a typical year. But if you do, you could benefit more from locking in a health coverage plan with lower copays.
Your copay costs also apply to prescription drugs you pick up at pharmacies. Even if you don’t visit your doctor often throughout the year if you have a monthly prescription, a higher copay could increase the cost of your medication.
Your current providers
If you have medical providers you like, ensure they’re in your plan’s network for both your employer’s and your spouse’s medical coverage. If your doctor is no longer in your network, you’ll likely pay more each time you visit them.
You’ll also want to make sure you understand how referrals work. If you are seeing a specialist, ensure you understand the rules required to continue seeing them under a new plan.
Coinsurance
Whether you max out your deductible each year or not, it’s a good idea to understand your healthcare plan’s coinsurance policy. Coinsurance is the amount you’ll pay for health care after you meet your deductible. For example, some plans might require you to pay 20% of all costs post-deductible. Even if you’re unlikely to reach your deductible, make sure you don’t sign up for a plan with a coinsurance rate that is too high and could leave you in a bad financial spot.
Vision, dental, and mental health costs
Not every healthcare plan comes with access to vision or dental insurance, so review the terms and covered services before selecting a plan.
Some healthcare plans also cover mental health costs, which may be important to your family. Be sure to read the fine print to ensure you have a full picture of all the pros and cons of each healthcare plan option.
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Things to keep in mind when buying health insurance after marriage
Buying health insurance after marriage involves considering both your and your spouse's healthcare needs. Here are some important things to keep in mind:
- Assess combined healthcare needs. Evaluate the medical needs of both you and your spouse. Consider existing conditions, potential future health concerns, and any planned medical procedures.
- Coverage options. Research the coverage options available to you. Compare plans from different insurers to find one that suits your combined healthcare needs and budget.
- Network of providers. Check the network of healthcare providers included in the insurance plan. Ensure that your preferred doctors, specialists, and hospitals are in-network to minimize out-of-pocket expenses.
- Coverage for family members. If you plan to start a family, ensure that the health insurance plan provides adequate coverage for maternity care, newborn care, and pediatric services.
- Costs and premiums. Consider the premium costs, deductibles, copayments, and coinsurance associated with the health insurance plan. Evaluate the overall cost of the plan to determine its affordability.
- Prescription drug coverage. Review the prescription drug coverage offered by the health insurance plan. Ensure that it includes medications that you and your spouse may need regularly.
- Wellness programs and benefits: Look for health insurance plans that offer wellness programs, preventive care benefits, and discounts on health services such as gym memberships or smoking cessation programs.
- Coverage for pre-existing conditions. Check if the health insurance plan covers pre-existing conditions. Some plans may have waiting periods or limitations for coverage of pre-existing conditions.
- Flexibility and portability. Consider the flexibility and portability of the health insurance plan. If you or your spouse change jobs or move to a different location, ensure you can retain the coverage or easily transfer it to a new plan.
- Customer service and support: Research the insurance company's reputation for customer service and claims processing. Choose a company known for its reliability and responsiveness to members' needs.
Other factors to consider
Aside from the main plan costs and services, review any additional offerings such as disability, life insurance, and healthcare plan options like flexible spending accounts (FSAs) and health savings accounts (HSAs).
Depending on your age, if you become eligible for Medicare, it may make more sense to stay on your spouse’s healthcare plan (as long as their employer has 20 or more employees). Instead, you can wait to enroll in Medicare, and may save money doing so.
Ways to reduce health insurance costs
Reducing health insurance costs after marriage requires strategic planning and careful consideration of various factors. Here are some tips to help you lower your health insurance expenses:
Combine coverage
If you and your spouse have separate health insurance plans through your employers, compare the coverage options and costs. In some cases, enrolling both of you in one employer-sponsored plan may be more cost-effective rather than maintaining separate coverage.
Explore spousal discounts
Some employers offer spousal discounts on health insurance premiums if both spouses enroll in the same plan. Check with your or your spouse's employer to see if such discounts are available.
Choose a high-deductible plan
High-deductible health plans (HDHPs) typically have lower premiums than traditional plans. Consider pairing an HDHP with a Health Savings Account (HSA) to save for tax-free medical expenses.
Consider catastrophic coverage
If you and your spouse are relatively young and healthy, you may qualify for catastrophic health insurance plans with low premiums but high deductibles. These plans provide coverage for major medical expenses and can be cost-effective for those who don't expect to use healthcare services frequently.
Take advantage of wellness programs
Many health insurance plans offer wellness programs and incentives for healthy behaviors such as regular exercise, preventive screenings, and smoking cessation. Participating in these programs can improve your health and lower your insurance premiums.
Shop around annually
Health insurance premiums can change yearly, so reviewing your options annually during the open enrollment period is essential. Compare plans from different insurers to see if you can find a more affordable option with similar coverage.
Consider health savings accounts (HSAs) or flexible spending accounts (FSAs)
These accounts allow you to set aside pre-tax money for eligible medical expenses. Contributions to HSAs are often paired with high-deductible health plans and can help you save on taxes while covering medical costs.
Utilize preventive services
Many health insurance plans cover preventive services such as annual check-ups, vaccinations, and screenings at no additional cost. You can avoid more costly health issues by staying up-to-date on preventive care.
Review your coverage needs
Assess your healthcare needs and usage patterns to determine if you can better adjust your coverage to suit your current situation. For example, if you rarely visit the doctor, you may be able to switch to a plan with higher deductibles and lower premiums.
Consider supplemental insurance
Depending on your circumstances, supplemental insurance policies such as dental, vision, or critical illness coverage may be more cost-effective than adding these benefits to your primary health insurance plan.
Related: Insurance & Financial Planning
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- 100% Online Application.
- Fast Coverage.
Should you combine health insurance coverage?
Depending on your specific medical situation, it may make sense to have more than one insurance plan, your individual plan and one from your spouse. This could help lower your total costs for healthcare, especially if it helps you meet your out-of-pocket maximum sooner.
For example, according to the Affordable Care Act, the most a family could pay for a Marketplace plan is $18,900 per year.
Does combining health insurance make sense?
Choosing between your spouse’s healthcare plan and your workplace plan can take time, but it may save you money in the long run. Generally, paying for a family plan rather than two individual plans is more affordable. However, there are some instances where adding a spouse to your plan might not be financially beneficial.
Some workplace plans only allow you to add a spouse if they’re not eligible for a workplace healthcare plan. Others might levy a surcharge to add a spouse to your insurance plan, making it more expensive than remaining on separate healthcare plans.
The bottom line
Carefully assess your healthcare needs as a married couple and explore all available options to reduce health insurance costs without compromising coverage. This may involve consolidating coverage, taking advantage of employer benefits and discounts, considering high-deductible plans with savings accounts, and staying proactive with preventive care. Regularly reviewing and adjusting your insurance coverage as circumstances change can help you find the most cost-effective solution.
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Writer
Courtney Johnston is a freelance writer, specializing in finance, travel, and health. She has written for The Chicago Tribune, Benzinga, BestReviews, Mashvisor, Fundera, MoneyGeek, and The Culture Trip. She also teaches writing instruction at the University of Indianapolis. Courtney currently resides in Indianapolis.
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