Health Insurance When Both Spouses Work

Spouses tend to share a lot of things including bank accounts, mortgages, family income, savings, etc. But when choosing health insurance, a few things have to be considered.

Spouses will have to choose from the options available to them for health insurance when both of them work. Even if they do not work, or only one of them is employees, health insurance should be chosen after considering a number of factors. We answer some of the common questions here

Health Insurance When Both Spouses Work

When both spouses work, deciding on health insurance depends on the coverage being provided, the out-of-pocket costs you’ll incur, and the options available to you. Not all employers offer health insurance to their employee’s spouses. The ACA mandates health insurance by the employer to cover children under 26 years of age but does not include spouses. Given that both spouses are offered health insurance by their employer and both have the option to cover the other, they may go for any one of the following:

  1. Separate Coverage
  2. Dual Coverage
  3. Shared Coverage

Let us look at each of these options in detail below.

Separate Coverage Health Insurance When Both Spouses Work

Separate coverage means that each spouse will be covered by their own plans. They may or may not share the same clinics or doctors and will handle their costs separately as well. Going for separate coverage may be your only option if your employer does not allow you to cover your spouse on your plan. This may be if your spouse is already covered by their employer.

You may also go separate coverage if your employer charges a “spousal surcharge” for covering your significant other if they already have coverage from their own employer. If the spousal coverage is more than getting separate coverage, then the couple may go for separate coverage.

If you go for separate coverage and have kids, you may decide to cover the kids in both plans or under one plan only. Keep in mind that you will have to pay twice for your kids if they are covered by both plans. Compare your costs and if your child has any medical conditions before you choose how to go about it.

Dual Coverage Health Insurance When Both Spouses Work

Dual coverage health insurance means that each spouse is covered by their own as well as each other’s plan. This type of health insurance can prove to be more expensive but can provide more coverage to each individual. If you go for dual coverage, you have to pay two premiums every month. In return, you may be getting better coverage. For instance, if you go to the hospital and your medical expenses total at $10,000. Your own employer-provided plan may cover 40% of the total expenses while under your spouse’s plan, you may get another 40% coverage. This way, you only pay 20% out of your own pocket, instead of 60% if you were covered separately. In some cases, dual coverage covers the entire medical costs.

Shared Coverage Health Insurance When Both Spouses Work

Shared coverage means that both the spouses select which plan is the best plan in terms of coverage and cost and both spouses get coverage on that plan. The other spouse declines his or her plan. This is one of the most common ways for families to get insurance. It is cheap as you pay for only one insurance and sometimes the spouse who declines employer insurance gets a small financial bonus for saving the company money.

Before you choose which plan to go for, check how each is priced. One employer may offer low deductibles for you, but a higher premium for spousal coverage. The other may offer to cover the entire family for less. You should also compare the benefits of each plan. A cheaper plan may have high deductibles and copays for lesser coverage, so you may be paying more in real. This especially carries weight if any member of your family has a lot of health problems.

If you already have a doctor that you go to, you might want to check if they are included in your insurance provider’s network.  If not, they might be a part of your spouse’s employer insurance. You could choose the plan that covers your regular doctor even if it is more expensive.

Health Insurance When Both Spouses Work For The Same Company

If both the spouses work at the same company, they may enroll in a single plan or enroll separately as well. Your monthly premium will probably not change whether you enroll separately or together, however, your employer’s contribution towards your monthly premiums may change. For instance, if your company only pays for employee’s premiums and not the dependant’s then you may want to enroll separately.

Can I carry my spouse on my health insurance?

Yes, you can carry your spouse on your health insurance plan, given that your employer-provided plan allows that. Under the Affordable Care Act, there is no compulsion on the employer to provide coverage to the spouse as well. However, most employers do cover dependants including the employee’s spouse.

Should Both Spouses Get Health Insurance?

It is best for each individual to have his or her own health insurance. Whether you’re married or living in a domestic partnership, each one should be covered under a health insurance plan. The coverage could be under the employer’s plan or under an individual plan purchased from the marketplace.

Dual Health Insurance Coverage Rules

Dual health insurance can increase the combined coverage available to you under both plans. When using dual coverage, one insurance plan acts as the primary plan and the other as the secondary plan. The insurance holder does not get to decide which plan is primary and which is secondary. Both plans provided work together to cover claims for the insurance holder. This is known as ‘coordination of benefits’.

How do you determine which health insurance plan is primary and which is secondary? If you are covered by your own plan as well as your spouse’s plan, then your own plan acts as the primary insurance plan. It will pay for the claim as if the secondary plan does not exist. Whatever amount is leftover will be covered by the secondary plan. The total amount reimbursed to you will not be more than what the total bill is.

Health Insurance For Married Couples

29% of couples choose to go with a separate health plan. There are a couple of options that married couples could go for.

  1. Couples health insurance plan: You both will be covered by the same plan and get the same coverage and benefits. This is not a good choice when you both may have different health needs.
  2. Employer coverage: If both of you are employed and offered health coverage by your employers, you could go for a combined, dual, or separate health insurance plan. If one spouse is unemployed, they can be covered by the other’s plan.
  3. Individual coverage: You may opt for individual plans that cover each one separately and are not offered by your employer. This is especially helpful if you have separate health needs or different doctors.

Whichever policy you go for, make sure you consider your medical needs and other costs. FOr instance, if you’re a young couple, you might want to go for a policy that covers pregnancy, and other basic hospital costs. If you’re an older couple, consider a policy that provides coverage for age-related conditions. Compare costs and talk to an insurance agent before you decide on a plan.

Charles Bains

Charles Bains

Charles Bains started his insurance career as a marketing intern before pounding the pavement as a commercial lines agent in Orlando, FL. As an industry journalist, his articles have appeared in a variety of trade publications. His insurance television career, short-lived but glorious, once saw him serve as the expert adviser on an insurance-themed infomercial (yes, you read that correctly). Having recently worked for various organizations, coupled with his broader insurance knowledge, Charles is able to understand our client’s needs and guide them accordingly. He is a gem for Insurance Noon as his wide area of expertise and experience have been beneficial in conducting further researches to come up with solutions and writing them in a manner which is easy for everyone including beginners to comprehend.

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