The (Not-So-Sexy) Guide to Combining Health Insurance

Make sure you’re covered!

Updated 09/06/17

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You’ve planned a wedding, walked down the aisle, and signed your marriage license. The romance isn’t over, but now that it’s legal, it’s time to think about the less exciting aspects of getting married, like changing your name, making financial plans, and addressing your healthcare. Getting married is a life status change, meaning now is the time for you and your partner to sit down and think about whether you want to combine your coverage onto a family plan. Not sure where to start? We spoke to Julie McCarter, Vice President for Core Solutions at Cigna, about how the process works and the things you’ve definitely got to consider.

How does the process of combining coverage work?

“Marriage qualifies as a life status change, so you can add your new spouse to your health plan (or vice versa) even if it is not open enrollment season,” says McCarter. “However, some employers do have a time limit for doing this. Be sure to check with your employer well ahead of your wedding so you know how much time you have!” From there, follow your plan’s protocol for adding a dependent to your plan.

Why should couples combine their coverage?

Each couple should determine which coverage options work best for them. “Review the features of each of your plans, and determine what is important to you,” McCarter says. “For example, look at physician and hospital networks, premiums and costs (like deductibles, co-pays, and coinsurance), and the materials available from each plan.” McCarter recommends looking at the following factors:

Are your usual doctors, such as your primary care physician, in the plan’s network? If not, does the plan offer out-of-network benefits that will allow you to continue to use your current doctors?

  • What are the premium costs (the amount your employer will take out of your paycheck for the cost of insurance)? Adds McCarter, “Some employers don’t allow spousal coverage if the spouse has access to their own employer-sponsored insurance, while others have a surcharge for spousal coverage. Compare the costs closely, as it may actually be less expensive for you each to have your own coverage.”
  • Compare the plan designs, including the deductible, out-of-pocket costs, copays, etc. “Factor these expenses into your budget for the year,” says McCarter. “Often, a plan with a high deductible may still be the least expensive when you consider plans’ expenses.”
  • Does the plan have a Health Reimbursement Account (HRA) or Health Savings Account (HSA)? If it does, your or your partner’s employer is likely contributing tax-free dollars into the account that you can use for health care expenses. Consider how much the employer is contributing for single coverage, compared to what they would contribute to family coverage.

  • Does the plan offer incentives or rewards? For example, a plan might reduce your premium if you take a health assessment or participate in a health coaching program. “Incentive programs for healthy behaviors are very common, and should factor into your evaluation of the overall cost and value of the plan,” says McCarter.
  • Is non-medical coverage (such as vision, dental, critical illness, and accidental injury insurance) included? What would those separate costs be?
  • Don’t forget ease-of-use and customer experience! “Not all providers are the same, and you might prefer the customer call hours of one plan over another, or the online or mobile tools of a particular plan,” McCarter continues. “Many health plans have focused on helping individuals understand the value of their benefits, so think about which plan actually works the best for you.”
  • When shouldn’t couples combine their coverage?

    “If you’re dissatisfied with any of the answers above, consider keeping your coverage separate,” McCarter explains. “If the plan doesn’t cover your doctor or facility, is too expensive, or is inconvenient, you may be better off keeping the plan you have.

    Are there any changes couples should make to their coverage as they combine policies?

    “This is a great time to assess your present and future benefit needs,” says McCarter. “You may have an opportunity to add coverage you hadn’t chosen in the previous enrollment period, such as vision or dental, critical illness insurance, or accidental injury insurance.” It’s also a good time to consider the value of a health savings account, if it is offered, as a way to set aside funds for potential health care needs down the road.

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