Is it Right to Have a Split Health Plan with your Spouse?

Many people believe, once you are married everything becomes shared property. You combine your two lives into one. This isn’t always the case. When it comes to important issues such as finances and health insurance, some couples choose to combine their accounts and policies, and some keep them separate.

As a married couple, should you have a separate health insurance plan from your spouse? More than likely your initial answer would be yes. Your thought is, it would be less expensive. For some couples, this actually isn’t the case. The choice to have a split health plan from your spouse depends mainly on what each of you needs separately regarding medical coverage.

Insurance Coverage

Health insurance coverage is a primary necessity for most people. Good medical coverage protects you from the high cost of unexpected medical bills due to disease or injury. Many health plans also cover preventative care such as vaccinations, screenings, and check-ups.

There are a variety of health plans for individuals, couples, and families. The most common types are Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Exclusive Providers Organizations (EPOs), High-Deductible Health Plans (HDHP), and Point-of-Service Plans (POS).

Many HDHP Plans allow a link to a Health Savings Account (HSA) to offset some of the out-of-pocket costs. An HSA is an account where you can set aside tax-free money to pay for qualifying medical expenses. These expenses can include deductibles, copayments, coinsurance, and out-of-pocket costs.

Other insurance options include Medicaid, Children’s Health Program (CHIP), and Medicare. All three programs are state-run and federally regulated. Medicaid and the Children’s Health Program (CHIP) are health insurance plans that provide medical coverage for eligible low-income adults, children, pregnant women, senior adults and individuals with disabilities. Some Medicaid plans pay directly to the health care providers, and others use private insurance companies to pay for medical coverage.

Medicare is a health plan for individuals that are 65 and older, adults with qualifying disabilities, and individuals with End-Stage Renal Failure.

 

Divided Insurance Coverage

Dividing insurance coverage for spouses can be done in several different ways with each spouse having their own health plan. A common way to divide medical coverage is when each person has their own employer-sponsored health plan with the company they work for.

Spouses can also have different plans purchased through the Marketplace, also known as the Exchange. The Marketplace are websites where people can find information and buy health insurance plans. The sites are both federally, and state supported. Couples can also choose to have one spouse with a health plan in the Marketplace and one spouse with a plan from out of the Marketplace.

When purchasing health insurance through the Marketplace, couples must file a joint tax return in order to be eligible for subsidies. Couples do not qualify for subsidies if a spouse can purchase employer-sponsored insurance through work but chooses to get coverage through the Marketplace.

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Same Health Plan or Choose Separate Plans?

Sharing health insurance may be an option if it’s an employer-sponsored plan that offers spousal coverage, and the cost of the monthly premium is reasonable. Many employers provide additional coverage for spouses and children but are not required to.

One insurance plan may be the best option if both spouses are healthy and rarely see a doctor. The benefits of sharing health insurance are one premium payment and a shared deductible. When purchasing a shared policy, make sure the plan has coverage for medical and preventative services for both spouse’s needs.

If one spouse has significant medical needs, and the other doesn’t, separate plans may be the way to go. The spouse that has more health care needs should have a plan with maximum medical coverage. This should include an extensive provider network. The cost of the premium will be much higher than plans with less coverage. The spouse with little or no health issues should have health insurance that has minimal coverage and much lower premium payment. This should offset the higher cost policy, and ensure both spouse’s medical needs are being met.

As a couple, it’s important to look at the different aspects of each health plan before deciding whether or not to share one policy. You should also take into consideration both spouses overall health, and lifestyle.

When looking at health insurance plans consider the cost of the premiums, deductibles, and any out-of-pocket expenses. Also, consider what type of medical and wellness services each plan offers. You should not only look at the medical coverage you currently have but other possible health plans that may fit both your needs.

 

Understanding the different types of medical coverage available is the best way to determine if having a separate health plan from your spouse is the right decision for you as a couple.

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