For new couples, starting a family can be a very exciting time. However, stress can easily pile up when insurance policies don’t cover an unexpected cost or monthly premiums become too much.
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 that can come with growing your family.
A lot of 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, there are multiple options available. We’ll be discussing them below.
When it comes to getting health insurance, it’s important to consider a few things. First, make sure that 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 are also critical factors to take into consideration. For example, if your partner has a pre-existing condition, then it’s best to prioritize plans that cover their specific needs. Also consider monthly premiums, out-of-pocket costs, and what you can afford to pay.
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.
When it comes to finding a health insurance plan for a married couple, there isn’t a “best” option. The reality is that picking a plan is highly specific to the individual, and depends on each person’s needs.
Below are some options for married couples who are looking for a benefit plan.
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, make sure that the plan is enough for both of your needs. Also, note whether the insurance plan covers pre-existing conditions or not.
While it may be easier to receive coverage through your partner’s employer, it may not be the best financial option. So, be sure to check premiums and out-of-pocket costs and discuss with your spouse if you both are comfortable with this change.
If both 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 to getting covered. Like all other insurance options, make sure 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.
Note that the Health Department assesses that roughly 80 percent of households qualify for at least some subsidy. But, it’s essential to make sure that 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, keep in mind that to be eligible for the premium tax credit, your modified adjusted gross income (AGI) should be between 100 and 400 percent of the federal poverty level (FPL).
Group health insurance is another plan type. As stated in the name, this insurance plan provides coverage to 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 typically pay a portion as well for additional benefits.
On top of affordability, you may also have the option to add on family members at no additional cost though it isn’t guaranteed.
Health insurance can get costly, without a doubt. But, there is an option to keep costs under control and limit your risk to a draining pocket cost.
Healthsharing is a more affordable, lower-cost alternative to traditional health insurance. Rather than buying a plan with high monthly premiums through a for-profit corporation, healthshare members form an association with like-minded people. This way, each member’s medical bills are evenly split amongst the group to lower individual costs and maximize health savings.
These associations are managed by tax-exempt, non-profit entities called Health Sharing Ministry Organizations. These organizations set and administer rules, collect monthly contributions, and distribute the funds to those in need. When a member receives a medical bill, they will submit the documents to the organization. If it qualifies for coverage under the plan rules, then the organization either pays the doctors and hospitals or reimburses the member for their expenses.
Unlike individual health insurance plans, healthsharing plans cost an average of 40 to 50 percent less than the unsubsidized cost of a comparable major medical plan.
It’s also important to note that these organizations are faith-based, but many have secular membership criteria. You also don’t have to practice a specific faith to benefit from healthsharing, though some plans do cater to specific communities.
Keep in mind that healthsharing isn’t for everyone, so research is important. For example, ACA subsidies don’t apply to healthsharers. However, many people still find that heathsharing still saves money after accounting for subsidies.
Healthsharing organizations can also impose waiting periods before paying for costs for pre-existing conditions, which isn’t typical for a traditional health insurance plan. That may mean looking at other options if you or your partner have pre-existing conditions, or are more genetically prone to them.
Also, there is no “open enrollment period” for health-sharing plans. This means you can join at any time. However, any life-changing events like marriage or children may mean that 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.
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, keep in mind that these may not have as many pregnancy benefits like a major health insurance plan would.
A Beneficial plan can cover services such as outpatient services, inpatient services, newborn baby care, and lactation counseling and devices. Moreover, coverage can vary depending on the type of plan you have 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 multiple factors such as your tier coverage, deductibles, copayments, and the type of provider you choose.
In short, yes. But 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 or change 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.
Also, family coverage may help expand your out-of-pocket maximum. In 2022, workers who were enrolled in a family coverage HDHP with a savings option paid $1,020 less in premiums on average. This was compared to those who chose a Preferred Provider Organization (PPO).
Depending on your plans and specific needs, it may be more beneficial to join a healthcare plan together. Not only do most employers provide some sort of 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.
If one spouse has insurance through an employer, it may help to look into spousal coverage as a beneficial plan. There is also the option of government-covered insurance like Medicaid or Medicare, depending if you qualify or not.
Depending on your current insurance, you may need to add your newborn to the plan months in advance 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.
First, the plan should provide you with adequate coverage so that quality healthcare is achievable for major medical events. You should also receive great 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, for the most affordable price possible.
Generally speaking, there’s never a perfect plan for married couples when it comes to 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 great plan comparisons, you can find the best coverage at an affordable price.