How Getting Married Affects Your Health Insurance

Getting married means lots of conversations about combining everything from last names to bank accounts. While picking a health insurance plan that covers both of you may seem practical, there are cases in which maintaining separate policies makes more sense.

Know Your Options

If you both have jobs that offer health insurance, it’s cheaper to accept your own health insurance plan because employers are required to pay 50% of the employee only coverage, and if they choose to pay more, they can. If the employer chooses to pay for spouse and dependents, they can. That’s up to the employer, but they are required to pay for ½ of the employee’s cost. So, it’s cheaper to accept your own plan and have your spouse do the same with their employer.

Not all couples have a choice when it comes to their health insurance coverage. If one spouse is unemployed or doesn’t have access to health insurance through their employer, then paying a higher monthly premium to include coverage for your spouse (and dependents if you have children) for a health insurance plan that covers all family members may be the only option. As of the writing of this article, if you have an employer that OFFERS coverage, whether you take it or not, just being offered, most likely you will not be eligible for a “subsidy” from the Government. There may be changes in the future, but for now, this is how it works. If OFFERED a plan at work, most likely you will NOT qualify for a subsidy.

Some employers contribute to spouse and children, others do not contribute. Each employer can decide to help pay for spouse and children premium. They are not required to help pay for spouse and dependents. This is the employer choice. They do, however, have to OFFER it. If the employer does not contribute, then spouse and kids will pay full price for their health plan. It’s then where the spouse and kids can look at other options. Getting quotes for a private plan may be a valid option.

DO NOT buy a health plan without speaking with a licensed agent. Many may turn to Nevada Health Link looking for a subsidy to help them pay their health insurance plan when they or a spouse have group insurance offered to them. This may result in paying thousands of dollars back to the IRS.

Deciding to Have Separate Policies or Get Your Own Private Health Plan

At one point, many employers provided outstanding health insurance plans that were superior to anything you could afford on your own. However, that’s not necessarily the case today. With the passing of the Affordable Care Act, pre-existing coverage is now solved if you buy an ACA (Obamacare) health plan. Maternity and mental health is also now covered too, and other benefits.

Many employers continue to offer benefit-rich plans, and even basic comprehensive plans cover a wide array of essential services. If one spouse has a greater need for a lower deductible plan, or the opposite and feel like they would be okay going with a higher deductible lower cost plan, staying together, or keeping separate health insurance plans is something to do your research on. It makes sense to do your research on all your options and weigh your costs of all options that meets all family members unique medical needs.

Deciding to Share a Health Insurance Plan

There is one big reason that sharing a health insurance plan may make the most sense if you have dependents and spouse: the annual out-of-pocket max limit. According to 2022 regulations, no family can be charged more than $17,400 for in network out-of-pocket costs on one policy, even if that policy includes multiple family members.

Consider this: if you and your spouse were in an accident and you both went to the hospital and both ended up with very large medical bills, generally speaking, the most you’d pay for all family members out of pocket maximum for 2022 would be $17,400. You’d need to check your individual plans’ “out of pocket maximum”. Health Savings Account HDHP’s are the exception for the $17,100 out of pocket maximum.

Finding the Best Health Insurance with Nevada Insurance Enrollment

Health insurance is complex and figuring out what fits your household’s needs can be a confusing process. At Nevada Insurance Enrollment, our health insurance agents specialize in helping households determine what options are available to them and how they can get the right coverage at an affordable rate.