Should my spouse have separate health insurance?

For choosing a health care plan during the benefit period open registrationThey may spend some time comparing the quality and cost of each plan. Or you might rely on due diligence from a few years ago and simply redo a plan that looked better at the time.

But covering both partners with a single plan is often the method of least resistance for many couples, and while it may be more cost-effective than covering them separately, it’s not always right. It’s not the method.

Some employers, especially very small employers, may not provide spousal coverage at all, especially if that spouse is entitled to coverage through their employer. Some companies may offer coverage to spouses of married employees, but do not extend the coverage to unmarried domestic partners. In either case, each partner must purchase their own health insurance.

Even employers who offer spousal protection may impose a “spousal surcharge” to ensure the spouse has access to their plan. This means that the cost for each partner to obtain insurance individually may be lower. Alternatively, you can subscribe to a plan with no additional charges.

Each partner’s health care needs may also influence the choice, especially if one spouse has higher health care utilization than the other. You can still get coverage for a gold-plated plan, even if it might result in less overall spending than choosing a plan that is cheaper but has a higher out-of-pocket expense. If the amount is high, higher quality plans tend to be better suited for children as well. Medical expenses can be reduced.

What health insurance do I need to have during my open enrollment?

If you are a couple or family member open registration Here are some of the key issues to keep in mind when deciding whether to opt for employee-only, employee-plus-one, or family coverage in 2022.

1) Compare costs between plans.

2) Understand medical needs and health insurance utilization.

3) Determine if dual coverage makes sense for you and your spouse.

Compare the cost of health insurance coverage under different plans: is traditional PPO or HDHP right for you?

Comparing costs between plans is an important starting point when deciding which spouse’s plan is best for you and whether to choose employee-only, employee-and-one, or family coverage. A complicating factor is that employers often have multiple options for coverage. Larger companies are more likely to deploy multiple types of plans than smaller ones, according to 64% of workers who will have more than one type of health insurance in her 2020 I was able to access it. Kaiser Family Foundation SurveyThis means that not only should couples compare the cost of employee-only, employee-plus-one, or family coverage for each plan, but they also need to compare the costs of multiple plan types by employer. There may also be

For many large companies, preferential medical facilities and health insurance with high deductibles are the two main options.Traditional PPOs typically have higher premiums but lower deductibles. On the other hand, plans with higher deductibles, as the name suggests, offer higher deductibles but lower premiums.View the premium, deductible, and coinsurance details for each plan to weigh the trade-offs. calculator It is designed to facilitate such comparisons.

When comparing the costs of employee-only coverage versus employee plus one or family coverage, it’s worth checking to see if the plan imposes a spousal surcharge. This is an additional fee charged to employees whose spouse has access to insurance through their employer. Imposing such a fee may make it more economical for each partner to be covered under their own plan. a quarter of employers A study by Willis Towers Watson found that they impose surcharges on their spouses. Additional fees may not apply if the spouse is unemployed or if the covered employee’s income is below certain thresholds.

Understanding medical needs and insurance policy usage

The next step in deciding which medical insurance to choose is to consider the medical needs and usage of each family member, including both spouses and children. Start with a rough estimate of each partner’s expected medical needs over the next year. If it’s not equal and you’re getting better coverage, albeit at a higher cost, that you use health care more frequently, then that’s a good argument to pursue another coverage. A person can opt for a more comprehensive and higher-priced plan, while a spouse who is expected to have fewer health care needs may opt for lower-cost, minimal coverage through their employer. .

Parents who split coverage can use their child’s medical needs to help determine which spouse’s plan will cover their child. It may make sense to get low-cost insurance through your parents with a plan that is affordable. On the other hand, if a parent values ​​peace of mind, better planning for their child may be worth the extra expense.

Does dual health insurance coverage make sense?

So far, we’ve discussed whether spouses should be covered by one partner’s plan or each plan. dual coverage, This means that both partners sign up for coverage for themselves and their spouses under their employer’s plan. The main advantage is that coverage is more comprehensive as each family is covered by two of her plans. Double coverage is obviously more expensive, but it doesn’t mean that each covered individual gets twice as much coverage as she does. Rather, one insurance company (usually the employees themselves) insurance— is considered primary insurance and the other is considered secondary insurance. However, for those who can afford both premiums, this type of coverage may be suitable if you anticipate very high medical bills over the next year. Having dual coverage may reduce your total out-of-pocket costs in these cases.

A previous version of this article was published on October 20, 2021.

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