How to Add a Spouse to Health Insurance
Understand what consolidating health insurance means., Know what to compare between plans., Compare out-of-pocket expenses between plans., Look at the levels of coverage provided by both plans., Determine how and if dependent children are covered.
Step-by-Step Guide
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Step 1: Understand what consolidating health insurance means.
Most health insurance offered by employers allows the employee to add coverage for a spouse (and/or dependent child).
Extra premiums are usually involved, some of which may be paid for by the employer.
If both you and your spouse work, and you both have health insurance, it may be worth consolidating your health coverage via only one employer., Before selecting one health insurance plan over another, compare several specific factors about both plans to determine which plan is the least expensive AND most valuable.
When comparing plans, compare the combined costs of the two plans you pay for now (plan A and planB) to the increased costs of either plan with a spouse added (planA+spouse and planB+spouse).
For example, compare planA+planB to plan A+spouse, and compare planA+planB to planB+spouse.
Whichever of the three options is the least expensive, but provides the most coverage, is the option you should choose.
Some of the specific factors to consider are:
The out-of-pocket expenses that each plan could generate for you.
The level and types of services and coverages offered by the plan.
Coverage for dependent children, if applicable. , Out-of-pocket expenses are any costs YOU would have to pay somehow.
These are the costs not covered by either your employer or the plan yourself.
Every health insurance plan has some out-of-pocket expenses to consider.Premiums — Some premiums are covered entirely or partly by the employer.
Compare the actual premium costs you have to pay between the plans.
In some cases your employer may pay the employee’s premiums, but not the additional spousal premiums.
Deductibles — Deductibles are any of the partial costs you have to pay for a specific service before the insurance company will reimburse you the rest.
For example, your insurance may only cover 80% of your prescription costs, therefore 20% of those costs are out-of-pocket.
Plan Maximums — Each portion of every health insurance plan usually has an annual and lifetime maximum you can be reimbursed for.
For example, your insurance plan may cover massage therapy up to $1,000 per year.
If you plan to go above the maximum of any portion of your plan, take that into account as an out-of-pocket expense.
Co-payments — Co-payments are similar to deductibles.
They are the out-of-pocket expenses you have to pay up front to see a doctor or specialist.
Some health insurance plans have different levels of co-pays based on who the coverage is for (e.g. employee vs. spouse), how many times you’ve been so far that plan year, and if it’s a family doctor versus a specialist.
Spousal Surcharges — Some employers have added a surcharge to their health insurance plans when a spouse, who already has health insurance, wants to be added to the plan.
Therefore, if your spouse already has health insurance through their employer, it may cost extra to add them to your plan., In addition to the costs associated with each option, you should consider the actual coverage offered by each option.
One option might be more expensive, but may offer significantly more coverage.Be sure to review what choices you have for doctors and hospitals under each plan, including whether you’re able to see an out-of-plan doctor if you so choose (if this is allowed, the co-pay is likely higher).
Look at what the minimum level of coverage is for hospital visits (e.g. private room vs. ward, etc.).
Compare therapeutic items that are and are not covered by each plan.
If you know you have to go to physiotherapy for 6 months, and it isn’t covered by one option, take that into account.
Determine what types of prescription and non-prescription medications are covered.
Some plans only cover generic drugs, others will cover the cost of brand name drugs.
Some plans have a limit on the pharmacy service charge they’ll cover.
Some plans will cover non-prescription drugs. , Even if you do not have dependent children at the moment, take into consideration if you’re planning to have children in the future.
While a new baby is usually one of the reasons you’re allowed to change your health insurance coverage mid-year, if you can take care of it now, you may save yourself some time in the future.Also take into account what sort of pregnancy and maternity items are covered by both plans if you’re planning to get pregnant in the near future. -
Step 2: Know what to compare between plans.
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Step 3: Compare out-of-pocket expenses between plans.
-
Step 4: Look at the levels of coverage provided by both plans.
-
Step 5: Determine how and if dependent children are covered.
Detailed Guide
Most health insurance offered by employers allows the employee to add coverage for a spouse (and/or dependent child).
Extra premiums are usually involved, some of which may be paid for by the employer.
If both you and your spouse work, and you both have health insurance, it may be worth consolidating your health coverage via only one employer., Before selecting one health insurance plan over another, compare several specific factors about both plans to determine which plan is the least expensive AND most valuable.
When comparing plans, compare the combined costs of the two plans you pay for now (plan A and planB) to the increased costs of either plan with a spouse added (planA+spouse and planB+spouse).
For example, compare planA+planB to plan A+spouse, and compare planA+planB to planB+spouse.
Whichever of the three options is the least expensive, but provides the most coverage, is the option you should choose.
Some of the specific factors to consider are:
The out-of-pocket expenses that each plan could generate for you.
The level and types of services and coverages offered by the plan.
Coverage for dependent children, if applicable. , Out-of-pocket expenses are any costs YOU would have to pay somehow.
These are the costs not covered by either your employer or the plan yourself.
Every health insurance plan has some out-of-pocket expenses to consider.Premiums — Some premiums are covered entirely or partly by the employer.
Compare the actual premium costs you have to pay between the plans.
In some cases your employer may pay the employee’s premiums, but not the additional spousal premiums.
Deductibles — Deductibles are any of the partial costs you have to pay for a specific service before the insurance company will reimburse you the rest.
For example, your insurance may only cover 80% of your prescription costs, therefore 20% of those costs are out-of-pocket.
Plan Maximums — Each portion of every health insurance plan usually has an annual and lifetime maximum you can be reimbursed for.
For example, your insurance plan may cover massage therapy up to $1,000 per year.
If you plan to go above the maximum of any portion of your plan, take that into account as an out-of-pocket expense.
Co-payments — Co-payments are similar to deductibles.
They are the out-of-pocket expenses you have to pay up front to see a doctor or specialist.
Some health insurance plans have different levels of co-pays based on who the coverage is for (e.g. employee vs. spouse), how many times you’ve been so far that plan year, and if it’s a family doctor versus a specialist.
Spousal Surcharges — Some employers have added a surcharge to their health insurance plans when a spouse, who already has health insurance, wants to be added to the plan.
Therefore, if your spouse already has health insurance through their employer, it may cost extra to add them to your plan., In addition to the costs associated with each option, you should consider the actual coverage offered by each option.
One option might be more expensive, but may offer significantly more coverage.Be sure to review what choices you have for doctors and hospitals under each plan, including whether you’re able to see an out-of-plan doctor if you so choose (if this is allowed, the co-pay is likely higher).
Look at what the minimum level of coverage is for hospital visits (e.g. private room vs. ward, etc.).
Compare therapeutic items that are and are not covered by each plan.
If you know you have to go to physiotherapy for 6 months, and it isn’t covered by one option, take that into account.
Determine what types of prescription and non-prescription medications are covered.
Some plans only cover generic drugs, others will cover the cost of brand name drugs.
Some plans have a limit on the pharmacy service charge they’ll cover.
Some plans will cover non-prescription drugs. , Even if you do not have dependent children at the moment, take into consideration if you’re planning to have children in the future.
While a new baby is usually one of the reasons you’re allowed to change your health insurance coverage mid-year, if you can take care of it now, you may save yourself some time in the future.Also take into account what sort of pregnancy and maternity items are covered by both plans if you’re planning to get pregnant in the near future.
About the Author
Teresa Armstrong
Enthusiastic about teaching cooking techniques through clear, step-by-step guides.
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