Marriage and Spousal Health Insurance Coverage

There are many financial benefits to getting married. Married couples can enjoy tax benefits and get health insurance under their spouse’s insurance plans. This can lower the cost of health care and provide better provider options for spouses.

Insurance regulations fall under state and federal law. Spousal insurance coverage options can depend on where you live. For specific information about marriage and spousal health insurance in your state, talk to a local health insurance attorney.

Can You Get Health Insurance After Getting Married?

Most people can get health insurance coverage under their spouse’s insurance plan after getting married. The majority of employers offer spousal coverage under their employer-sponsored plans. The Affordable Care Act (ACA), also known as “Obamacare,” only requires employers to cover dependent children. However, most health insurance companies also offer family plans to include spouses.

Generally, enrollment is done through your spouse’s employer. Contact your spouse’s human resources department after getting married to find out what you need to get coverage. There may be a limited enrollment window, or you will have to wait for that year’s open enrollment period.

There are other ways to get health insurance if you don’t want to enroll in your spouse’s plan. Lower-income households may be able to get Medicaid health coverage. Older Americans can get Medicare for health insurance. Military veterans generally qualify for VA health care. If you don’t meet the eligibility requirements for these government programs, you can buy insurance through your state’s health insurance marketplace.

Is Marriage a Qualifying Event for Health Insurance Coverage?

Insurance companies limit changes to health care plans except during the open enrollment period. The open enrollment period is a limited time when you can add, drop, or change your coverage. However, you can also make changes during qualifying life events.

A qualifying event is a life change that allows you to make changes outside the open enrollment period. Qualifying life events for health insurance plans include:

• Marriage
• Divorce
• Death
• Birth of a child
• Loss of coverage
• Change in residence

The special enrollment period also has a limited window after marriage. Employer-based plans must provide at least 30 days for enrollment after a qualifying event. However, some insurance companies offer more time to make special enrollment changes.

Health coverage enrollment is not automatic. After marriage, you may need proof of your legal marriage to enroll in your spouse’s plan. Generally, you need to provide a copy of your marriage certificate to enroll your new spouse.

Is Spousal Coverage More Expensive?

Spousal coverage will likely cost more than health coverage for just your spouse. This depends on the employer and the insurance provider. Some employers cover spouses at the same rate. Other employers do not subsidize coverage for the spouse.

The cost of spousal coverage can also depend on whether you have access to your own employer-sponsored insurance. If you have employer-provided health insurance but opt for coverage under your spouse’s plan, the insurance company may charge an additional spousal surcharge.

Can You Keep Separate Health Insurance After Marriage?

You don’t have to sign up under your spouse’s health insurance policy after getting married. You can stay with your current individual plan. You can also sign up under your spouse’s plan, or your spouse can switch over to your plan. Compare your coverage options and health care costs before deciding what changes to make.

Compare the costs of your health care under your current plan and under your spouse’s plan. Include all your costs, including deductibles, monthly premiums, copays, and out-of-pocket maximums. Find the lower-cost health insurance option that provides the best care.

How Long Does It Take to Get Health Care After Marriage?

Coverage after getting married can take some time. You must notify your spouse’s employer during the special enrollment period. Depending on the company, coverage can start immediately after enrollment or the first day of the next month. If you miss the special enrollment period, you have to wait until the employer’s next open enrollment period, which could be months away.

To get coverage as soon as possible after marriage, contact your HR department and review your insurance plan documents. If you have legal questions about insurance coverage after marriage, talk to an attorney for legal advice.

Do Same-Sex Couples Qualify for Spousal Insurance?

Same-sex married couples have the same legal rights as opposite-sex couples. You can get coverage if your spouse has employer-sponsored health insurance that includes spousal coverage. The majority of American employers offer plans that include coverage for spouses.

Can a Lawyer Help With Health Coverage?

Dealing with the insurance company is often frustrating. It is hard to get a straight answer about health insurance plans when you need health benefits. If the insurance company denies coverage after getting married, you can appeal. If you can’t get help, you can turn to an experienced attorney. A health insurance lawyer can help newlyweds with legal questions, including spousal insurance coverage. They can deal with the insurance company so you can get the health care coverage you need.