How Does a Qualifying Life Event for Marriage Work?

Congratulations on your wedding. As you realize, marriage is more than the big day. It’s the creation of many intricate connections, and one people sometimes forget is your health insurance coverage.

Tara Stombaugh, Director of Consumer Sales and Client Services with Avera Health Plans, offers these facts on decisions you should consider, what can and cannot legally occur and how to best navigate your best next steps to ensure you and your family remain covered.

Is Marriage a Qualifying Life Event?

Having a baby, losing your health coverage —or getting married -- all are examples of what are known as qualifying life events in health insurance. A qualifying life event opens a window of time where you can enroll or change the coverage you have. These events can happen any time, even outside of the yearly open enrollment period.

Consider Your Health Insurance Options

You may have a plan through your employer or the federal Marketplace. Marriage provides options to add, change or consolidate plans.

Your insurance provider will likely require a certified certificate of marriage before you or your spouse can be added to a plan.

While marriage often brings about positive changes in health insurance coverage, it's essential for couples to review and understand the specifics. This can include:

• Examining the extent of coverage
• Looking at all out-of-pocket costs
• Ensuring knowledge of any limitations or exclusions

Other considerations when you get married:

• Marriage can affect eligibility for certain programs. Medicaid, for example, takes household income into account when determining eligibility.
• Married couples who are 26 or younger and covered under their parents’ insurance can remain on the plan until they reach that age.
• You can also explore additional coverage options, such as dental insurance or vision insurance, to address specific health care needs. These supplemental plans can enhance the overall scope of coverage and provide a more comprehensive approach to insurance.

Making the Most of Employer-Sponsored Health Insurance

Individuals who obtain health insurance through their employers can consolidate coverage for a spouse.

Couples who do their homework have peace of mind so they can enjoy a honeymoon or other just-after-the-wedding plans.

“Consolidation can save money and increase access to care services,” Stombaugh said. “Employer-sponsored family plans typically cover spouses and children, offering complete coverage for the entire family.”

In addition, married couples can consider options that have expanded under the Affordable Care Act (ACA). The law allows individuals and families to purchase insurance through the Health Insurance Marketplace. Since marriage is considered a qualifying life event, it marks the start of a 60-day special enrollment period in the Marketplace.

The qualifying life event applies regardless of where you seek coverage, be it the Marketplace or place of employment.

Separate or Combined Insurance for Working Couples

Spouses don’t have to combine their insurance. In some cases, each spouse might have better individual coverage or premiums through their employer. In other cases, they might have the option to include the other in an employer-sponsored plan. Comparing and contrasting the choices of sharing coverage – or keeping your own with your own job – are vital steps to save money and ensure peace of mind.

“Open communication between spouses is crucial to ensuring that both individuals are aware of their insurance options,” said Stombaugh.

Joint coverage can be particularly beneficial in managing health conditions, as both partners have access to the same network of health care providers and facilities. On the other hand, keeping two coverages, through two employer-based plans, might make more sense.

“When one spouse has more expected health care needs for the year ahead, it can make more sense to use separate coverage,” said Stombaugh. “Overall health, age and gender all play a part in the cost of a policy.”

So if you love your current coverage, and your spouse does, too, you might want to stay put with health insurance, even though you can make changes. “No two couples are the same, nor are their options for good coverage,” Stombaugh added.

When Changes Occur in a Marriage

In the unfortunate event of a spouse’s death, health insurance considerations become important, so make sure your legal arrangements regarding health insurance coverage are something you both know well.

Both spouses also should be familiar with what changes happen in the event of a separation or divorce.

“No one wants to talk about these sorts of things, but peace of mind comes with knowing your loved ones will have coverage if something happens,” Stombaugh added.

Talk to an agent to learn more about your options or learn more about our plans.