How Marriage Qualifies Couples for Special Enrollment in Family Health Insurance?
Marriage represents a major life transition that entails new responsibilities. It alters both personal and emotional relationships and also meaningfully affects health insurance coverage. Under the Affordable Care Act (ACA), marriage grants couples access to a Special Enrollment Period (SEP), enabling them to include their spouse in their existing medical insurance plans or to opt for a family health insurance plan outside the standard open enrollment timeframe.
Confused about what a special enrollment period is? Let’s explore.
Understanding the Special Enrollment Period
The special enrollment period allows you to enroll in medical insurance plans outside the annual Open Enrollment Period. For many couples, marriage qualifies them for a Special Enrollment Period (SEP), enabling them to add their spouse to their health plan or switch to a family health insurance plan outside the annual open enrollment period.
Furthermore, it is important to note that specific criteria must be met to qualify for this special enrollment opportunity.
- Losing health coverage
- Moving out
- Getting married
- Having a baby or adopting a child
- If your household income is below a certain amount.
Generally, you have a 60-day window from the date of a qualifying event, such as marriage for couples, to enroll in a coverage plan. However, if you belong to a federally recognized Indian tribe or an Alaska Native Claims Settlement Act (ANCSA) Corporation, you have the flexibility to enroll in or modify your plans once a month throughout the year without the requirement of an additional qualifying life event.
You can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) at any time.
| Note: Remember, the special enrollment period does not apply in India. As a result, you must be absolutely certain of what insurance plan you are purchasing and from whom. |
How Does Marriage Qualifies for Special Enrollment?
Marriage serves as a qualifying life event that enables you to enroll in or modify your family health insurance plan outside the standard enrollment period. Upon getting married, both you and your spouse have the opportunity to either apply for coverage under a shared plan or include each other in your existing policies. It is important to note that there is a limited timeframe to implement these changes, usually within 60 days following the marriage date.
This special enrollment opportunity applies to various health insurance plans, including those purchased through the Health Insurance Marketplace, as well as employer-sponsored insurance. However, keep in mind that the rules for employer-sponsored plans differ from the regular individual health plans.
Key Considerations After Marriage
When purchasing health insurance plans for family, you must consider the following to avoid conflicts in the end.
Changes in Premiums
Adding a spouse to your health insurance plans for family can increase your monthly premiums. Hence, you must plan your budget accordingly. On the other hand, you may also benefit from the cost-sharing arrangement of a family plan, which can reduce your financial burden.
Understand Your Coverage
Every person has different needs. Your necessities may not align with those of your partner. For example, you may require dental and vision coverage, while your partner might prioritise preventive care. It is important to comprehend the coverage provided by your insurance plan and to determine if any additional riders or supplemental policies are needed.
Coordination of Benefits
Coordination of benefits enables health and prescription coverage plans to identify which insurance plan is primarily responsible for payment when you are enrolled in Medicare and have multiple coverage options. It also clarifies the level of contribution from the other plans involved.
Wrapping Up
Marriage has a significant impact on your health insurance coverage. All credits to the Special Enrollment Period. Couples have the opportunity to adjust or choose health insurance plans for family that align with their evolving requirements. It is essential to enroll within the 60-day timeframe to ensure uninterrupted coverage and to prevent any penalties or lapses in health insurance.
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