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Best Health Insurance for Couples Planning a Family

HealthPlans of NC

Starting a family can be very exciting for new couples. However, stress can easily pile up when insurance policies don’t cover an unexpected cost or monthly premiums become too high.

In fact, according to the Kaiser Family Foundation, the average monthly premium for a “Silver” plan covering a 40-year-old married couple was $1,120. That’s not considering all the possible pocket costs of growing your family.

Many unknowns can leave couples asking, “What options work best for us?  What can we expect when we decide to have children? And, what is the best health insurance for couples planning a family?”

While the answer isn’t clean-cut, due to individual needs and affordability, multiple options are available. We’ll be discussing them below.

What to Consider When Getting a Couple's Health Insurance

When getting health insurance, it’s essential to consider a few things. First, ensure you and your partner are comfortable with coverage under the same plan. With a bit of research, you can find the perfect plan that suits both of you.

Weighing your family's needs is also a critical factor to consider. For example, if your partner has a pre-existing condition, it’s best to prioritize plans that cover their specific needs. Also, consider monthly premiums, out-of-pocket costs, and what you can afford.

Lastly, consider whether your plan should cover just the two of you if you should buy a family plan. Do you have children, or are you planning to? That can impact what your health insurance plan may look like and how much you pay.

Health Insurance Options for Married Couples

When finding a health insurance plan for a married couple, there isn’t a “best” option. Picking a plan is highly specific to the individual and depends on each person’s needs.

Below are some options for married couples seeking a benefit plan.

Couples Planning Insurance

Health Insurance Spouse Coverage

One of the first options couples look at is their spouse’s employer plan, also known as spousal coverage.

Spousal coverage is a great way to get health coverage. However, ensure the plan is enough for both of your needs. Also, note whether the insurance plan covers pre-existing conditions.

While receiving coverage through your partner’s employer may be easier, it may not be the best financial option. So, check premiums and out-of-pocket costs and discuss with your spouse if you are both comfortable with this change.

Dual Health Insurance Coverage for Married Couples

If you and your partner are actively working, you may be eligible for insurance through your employers. This is called dual coverage, which can be a great route. Like all other insurance options, ensure that the coverage is enough for your individual needs and covers pre-existing conditions.

You can also receive benefits through the government with programs like Medicaid or Medicare.

The Health Department assesses that roughly 80 percent of households qualify for at least some subsidy. But, it’s essential to ensure the coverage is enough for you or your partner’s needs.

If you qualify, you may be able to get health insurance at a reduced rate. You could also receive a premium tax credit, which helps low-income individuals and families afford health insurance through the Health Insurance Marketplace.

However, remember that your modified adjusted gross income (AGI) should be between 100 and 400 percent of the federal poverty level (FPL) to be eligible for the premium tax credit.

Group Insurance Policy for Family

Group health insurance is another plan type. As stated in the name, this insurance plan covers a whole group of workers under one company or specific organization.

Group plan members typically have a lower premium rate since the risk to the insurer is spread across multiple holders. Therefore, employers usually pay a portion of the additional benefits as well.

In addition to affordability, you may also have the option to add family members at no additional cost, though it isn’t guaranteed.

Also, there is no “open enrollment period” for health-sharing plans. This means you can join at any time. However, life-changing events like marriage or children may mean you qualify for a “special enrollment period.” This gives you a 60-day window to join a health insurance plan outside general enrollment. This period runs from November 1st through January 15th for ACA-qualified health insurance.

Which Health Insurance Policies Cover Pregnancy?

Pregnancy and childbirth can be stressful and scary times for women and couples. The good news is that the right insurance covers all necessary procedures.

Under the Affordable Care Act, pregnancy and maternity care is one of the ten essential health benefits that must be covered by health insurance plans. Even without health insurance, there may be free or discounted services for expecting mothers in your area. There are also affordable options like hospital indemnity policies. However, remember that these may not have as many pregnancy benefits as a major health insurance plan would.

A Beneficial plan can cover outpatient services, inpatient services, newborn baby care, and lactation counseling and devices. Moreover, coverage can vary depending on your plan type since insurers can choose how they cover these benefits.

Checking your plan’s policy on these benefits can also help you prepare for any out-of-pocket costs you may have to pay. The total amount will depend on factors such as your tier coverage, deductibles, copayments, and the type of provider you choose.

Family Planning

Does Health Insurance Cover Newborns?

In short, yes. However, not all insurance plans are equal.

For example, some insurers may cover your newborn for non-pregnancy-related procedures without a waiting period. Others, however, will require you to upgrade to a family policy 12 months before birth.

The good news is that having a newborn is a life-changing event. So, you would qualify for the 60-day enrollment window regardless of the open season. With that time, you can upgrade your policy to include your new child.

Speaking with your healthcare provider will help you decide your next move for newborn coverage. Plus, you’ll understand if your current insurer still provides you with the most beneficial plan postpartum.

Family coverage may also help expand your out-of-pocket maximum. In 2022, workers who were enrolled in a family coverage HDHP with a savings option paid an average of $1,020 less in premiums than those who chose a Preferred Provider Organization (PPO).

FAQs About Insurance for Married Couples

Is It Better for Husband and Wife to Have Separate Health Insurance?

Depending on your plans and specific needs, joining a healthcare plan together may be more beneficial. Not only do most employers provide some spousal insurance, but it could make things easier if you decide to have children. However, if one spouse is not comfortable joining healthcare plans or it’s more beneficial to remain separate, then individual insurance may be the best option.

What If One Spouse Has Health Insurance And The Other Does Not?

If one spouse has insurance through an employer, it may help to look into spousal coverage as a beneficial plan. Depending on whether you qualify, you can also choose government-covered insurance like Medicaid or Medicare.

Do You Add a Baby to Insurance Before Birth?

Depending on your current insurance, you may need to add your newborn to the plan months before the expected delivery date. Make sure to speak thoroughly with an expert from your insurer about your options and the process of covering your baby.

The Best Health Insurance Company for Married Couples

Healthcare plans are based on individual needs and affordability. That doesn’t change once you marry your partner. However, in most cases, picking the best plan involves two things.

First, the plan should provide adequate coverage to achieve quality healthcare for major medical events. You should also receive excellent care at a monthly premium you can afford, so lapses aren’t a concern.

Make sure to speak with a healthcare expert to ensure that you’re receiving the best care possible at the most affordable price.

Learn More at Health Plans of North Carolina

Generally speaking, there’s never a perfect plan for married couples regarding health insurance. There are also multiple plan types, like a Health Maintenance Organization (HMO) and a Preferred Provider Organization (PPO)

That doesn’t mean you can’t find the plan that best fits you. With proper research and significant plan comparisons, you can see the best coverage at an affordable price.

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