Health Insurance Coverage for Spouses/Partners

The Affordable Care Act has opened up a world of options for many Americans that either paid for expensive, insufficient health insurance or who were shut out of the health care system entirely.  Likewise, the legalization of same-sex marriage has impacted how couples can meet eligibility requirements for their spouse’s employer-sponsored health insurance plans. With these newfound benefits have come added complexity in how health insurance is managed by employers and offered on the private market, and it is important to understand how they work so that you can make the best choice for yourself and your family.

Spousal health insurance plans

Once you are married, you are eligible to join one another’s employer-sponsored health insurance.  Typically, employees may only make changes to health insurance during the open enrollment period, which normally takes place one month out of the year.  However, a marriage counts as a “qualifying event” that allows you to make changes to your health insurance coverage within 30 days of your wedding (ask your Human Resources Department for your employer’s deadline).  Note that if you choose not to make changes immediately after your wedding you will have to wait until your employer’s open enrollment period.  Changes to or loss of your spouse's health insurance coverage also qualifies as a life event, at which point your spouse is eligible to join your policy.  Either qualifying event might require documentation, such as your marriage certificate or a letter from your spouse’s employer detailing the change in his or her health insurance coverage.

Before you automatically jump on one another’s health insurance plans, be sure to do the math and compare features.  If you each have an individual policy at your respective jobs, the cost of those two plans might actually add up to be less than one family plan at either of your jobs.  You may also be subject to the “spousal surcharge,” where an employer will charge more for a family health insurance plan if it knows that a spouse has a health insurance plan available at his or her own employer.  This fee may eliminate any cost savings that you might have experienced by combining plans.  At the same time, you should review the features of your existing health insurance plans to make sure that they meet your needs.

If one of you receives health insurance from your employer, while the other buys private insurance from a health insurance exchange, it may indeed prove cheaper to take advantage of the employer-sponsored plan.  Again, check the costs of your polices against the cost of a family plan at your employer to make sure both the price and the coverage are better than what you are currently receiving.

If both of you are self-employed and have your own policy through the healthcare marketplace or through private health insurance plans, it may make sense to consolidate your policies into a family plan.  Do the math and compare the policies that you currently have and look at any subsidies that you receive too.  To purchase a family plan you and your spouse need to file your taxes jointly; this may disqualify you from receiving health insurance subsidies in the future.

Domestic partnership health insurance plans

Your employer may offer health insurance to domestic partners, either of the opposite or same sex, similar to that of a married couple.  Since domestic partnerships are not formally recognized by federal law, each state has its own definition.  Health insurance providers may ask applicants to prove their domestic partnership through:  letters from family and friends verifying the relationship, having the same permanent residence for the past six or more months, and sharing the costs of running a household.  In addition, neither of you can be married to anyone else, and you cannot be blood relatives to one another.  Employers may impose a waiting period from the time of application of six months to a year before the health coverage can begin.

If your employer does not extend health insurance coverage to domestic partners, you may turn to the health insurance exchanges or private insurance to find adequate coverage for you and your partner.  As you review policies read each carefully and compare it to your employer’s health insurance to make sure that you are getting comparable or better coverage.  If you do find a plan that serves you better you can sign a waiver of health insurance benefits with your employer.  At the same time, you should attempt to renegotiate your compensation package, as health insurance is a valuable part of your benefits package and by going without you can make the argument that you should be compensated in a different way.