Should Spouses Go For Separate Health Insurance Plans?

While you fit in the married box, you may still want to keep your health insurance status as single. Yes, that’s right. Most people think that going for health insurance as a couple may mean more sense. However, often going alone can make more financial sense.

This statement often rings true when two people get married, but their health care needs are often different. As in some cases, you may require more medical services than your partner.

A separate medical insurance plan may then come in useful. Here are some things to consider before choosing the perfect health insurance coverage for yourself and your spouse.

All about the Affordable Care Act

As per the Affordable Care Act‘s upper limit of out-of-pocket costs for an individual is $8,550, and it is $17,100 for a family. The family out-of-pocket limit is applicable for family members covered under a single policy. However, when the family splits up into more than one plan.

This includes both employer-sponsored insurance or individual market coverage. The family out-of-market limits are lower. So, when the spouses have one spouse on one plan and a separate one for another, each plan will have an out-of-pocket limit, and the total exposure will be much more than if the family is on one plan.

Healthcare Needs

If one spouse is healthy and the other spouse is suffering from medical conditions, the best financial decision may be to get separate policies.

The healthier spouse, in this case, may choose a lower-cost plan with a more restrictive provider network with higher out-of-pocket exposure. In contrast, the partner with medical conditions may need a higher-cost plan that needs a more extensive provider network and minimize the out-of-pocket costs.

This may not always be the case, especially if one spouse has a better company-insured plan that will offer them a reasonable premium. But in some circumstances, some families need separate plans based on individual medical needs.

Personal Preferences

Both of you may need a preferred doctor, specialist, hospital, or even a health insurance company. If it is so, you can take your preferences into account when you choose a health plan.

One health insurance plan may include you or your spouse’s chosen providers or hospitals in its network. Purchasing specific and separate plans may cost you more out of pocket and for premiums. But that may help you in the end as it will help you spend on a plan to get access to your preferred providers.

Ultimately, every couple needs specific plans such as state-based exchanges, employer-based plans, state-based exchanges, the federal marketplace, and the private marketplace. Think all about your specific healthcare needs and any specific treatment you may need in the near future, such as surgeries or having a baby. Then, compare the individual and family health plan costs and benefits.

Sponsored Health Insurance

Nearly more than half the Americans get their health insurance from an employer-sponsored plan by far is the single type of coverage. If both spouses work for employers that offer specific coverage, they will choose their plan.

If the employers offer collective coverage to spouses, they can determine whether they can choose separate plans or add one up to the employer-sponsored plan.

 Separate Prescription Deductibles

Prescription costs alone may need you to get a separate deductible plan. Medicine thresholds may get you to fulfill in a plan year than special medical treatment deductibles.

Marketplace plans may offer gold- and platinum-tier prescription plans. In 2019, there were as many as 48% of gold plans and 54% of platinum plans offering separate drug deductibles.

How Many People Are There on the Insurance Plan?

This may turn out to be a subjective consideration because if your existing family health plans are strong enough to include your spouse, then you may not need a separate health insurance policy. However, it would help if you kept these things in mind before making the decision.

For one, how many people may be there on the family health plan? Do you have dependents, like your parents, who may have specific medical conditions such as cardiac issues, high blood pressure, or at risk of stroke or more?

These kinds of indicators may cost you an extra significant amount in terms of hospital and insurance premiums, reducing your original family health plan. In such an event, you should avoid the family floater plans and buy specific family health plans that include maternity cover and all.