At 26, a new law school graduate, I just landed my first “real” job. And by real job, I mean a job with a salary and benefits — just six months before I am kicked off my parent’s health insurance plan.
My significant other, Ken, is an entrepreneur who starts working before sunrise, while I often work late into the evening as an attorney.
Though we fully intend to spend our lives together, we chose to live together rather than marry right away. But when I knew I would be getting insurance through my job, Ken and I talked about whether marriage would be a smart move for the health benefits. But after doing some preliminary research, we found no clear answer, because nothing about health insurance ever seems to be clear.
With the Dec. 15 deadline looming for the Affordable Care Act’s open enrollment period, I’m sure many couples like us are weighing whether to get insured through the ACA or – if this is an option – getting married to enjoy their partner’s employer-sponsored plan.
All couples are different (and so are many health insurance plans) so there are no easy answers. But remembering LOVE, both in the usual sense and as an acronym for what to look for while investigating insurance options, may help you find the right answer for you.
Look at insurance plans. This might seem obvious, but consumers tend to choose policies based on sticker-prices without considering important differences between the available plans that will directly affect real costs. Sal Cocivera, president of Cora Capital Advisors, suggests that couples compare not only co-pays and premiums, but also considers factors including ancillary services. Maybe the ACA plans appear to offer better savings, but if employer-based plans are affordable and meet the minimum coverage standards, premium tax credits and other savings might not be available.
It’s also important to consider how plans calculate annual deductible requirements. Some insurers calculate using the calendar year, while others use the plan renewal date. And while employer-sponsored plans might appear to offer nice extras, like health club memberships, Cocivera warns that some of the most appealing insurance benefits are only offered to the covered employee, not the spouse or dependents.
Also, look at which providers are included in the network of any plan you consider. Sometimes premiums are kept low through “narrow networks,” meaning that if a serious problem arises, you may not have access to the hospitals you want.
Obstacles. You can’t foresee all the challenges you will face, but some issues are predictable. Frequent travelers might not want an HMO because, unless there is a true emergency, care outside your network won’t be covered as readily as under a PPO. Another potential obstacle: will signing up for a certain plan mean you need to change your current doctors to get your care covered?
Vigilance. When deciding between plans, you might ask, “how do I know that my spouse’s wonderful health insurance plan is going to be as wonderful next year?” The answer is, you don’t. That’s why you must be vigilant in the pursuit of health coverage. Make it a priority to review health coverage offerings each year before the open enrollment period so you capture all available opportunities.
Expect the unexpected. Premiums and out-of-pocket expenses may increase, certain plans may cease to exist, others may take their place, even definitions may change. While the exact path of the health insurance market is unknown to even the most informed consumer, couples making this decision should always seek expert advice to keep up on the latest developments.
Initially, Ken and I assumed we would be better off if he were on my health benefits. But through careful review, we found that the cost of adding a spouse to my employer’s plan far exceeded that of Ken acquiring insurance on his own.
We are getting married. But we are keeping our health insurance separate.
Bottom line: Couples figuring out their health insurance coverage need the same skill required for navigating their relationship: Constant, candid communication.
Mara Smith is an associate at Montgomery McCracken Walker & Rhoads in Philadelphia, and a recent graduate of the Thomas R. Kline School of Law at Drexel University, where she concentrated in health law.