Congratulations on your engagement! Get ready for a whirlwind of excitement, dresses, tuxes, cake tasting… and possibly the biggest To-do List you’ll ever see in your life.
While navigating the waters of family drama and seating charts, it might be easy to postpone checking off some of the less exciting aspects of an upcoming marriage–such as how it affects your health insurance coverage.
Don’t worry! We’ve got a list of things to keep in mind so that you can spend more of your “in sickness and in health” in a healthy, happy place.
1. Employer-based coverage of one spouse can affect the other, even if they don’t intend to add the spouse to their plan.
Under the Affordable Care Act, if an employee is offered coverage that is considered affordable (less than 9.5% of a household’s gross income) and that plan meets minimum essential value (a plan covers at least 60% of total allowed cost of benefits)then that employee and his or her spouse are not eligible for financial assistance on the Marketplace. The assessment of affordability is based on worker-only coverage, and does not include the cost of adding a spouse or dependent.
2. What if neither my partner nor I are offered coverage through an employer?
All is not lost! If neither you nor your partner is extended an offer of coverage through an employer you may be able to get financial assistance on the Marketplace (www.healthcare.gov). Income restrictions do apply. If you already have a Marketplace plan (regardless of whether or not you actually enrolled), all you need to do is update your information! Just log on to your account or call 1-800-318-2596 to update all your household details. Couples have 60 days from the time they are legally wed to enroll in or change their marketplace coverage.
3. If you sign up for a new plan, be sure that your doctors are in-network.
Not all doctors participate in every network or accept all forms of insurance. So if you want to go to a specific doctor or clinic, be sure that they are in your plan’s provider network. Going to in-network providers helps ensure that you are getting the most out of your policy and can help minimize costs to you. Just because a provider accepts your insurance or is part of some networks doesn’t mean that he or she is in-network for your specific plan. The best way to verify this is to call your doctor, as some provider search functions on insurance company websites are not always up-to-date.
4. Update your Marketplace application!
If anything else changes over the course of the year, always update your marketplace account. New address? Change in income? Gaining a dependent? Update those deets! You’ll be glad you did come tax time – facing an unexpected payment to the IRS because you received too much financial assistance wouldn’t make anyone happy.
5. You have 60 days to enroll in or make changes to Marketplace coverage
The Open Enrollment Period is the annual period when people can enroll in a health insurance plan. For 2016 coverage, the Open Enrollment Period was November 1, 2015 – January 31, 2016. The next open enrollment period is Nov. 1, 2016 to Jan. 31, 2017.
The good news for you is that the act of marrying is considered a “qualifying life event” that triggers a Special Enrollment Period for newlyweds. Couples have 60 days from the time they are legally wed to enroll in or change their marketplace coverage.
If you would prefer to have someone talk you through all your options, get in touch with a free in-person assister in your area by going to www.getcoveredamerica.org.
6. Your combined household income may change the amount of financial help you receive from the Marketplace
If one or both people previously received a premium tax credit based on filing ‘single without dependents,’ changing your application to reflect a spouse will almost certainly change the amount of financial assistance the combined household receives. In some cases, you may receive more money. In some cases you may receive less overall. Keep this in mind as you shop for coverage.
7. Married filing jointly: a requirement for receiving financial assistance
In the majority of cases, married couples can only receive financial assistance if they intend to file a joint federal tax return for the year in which they receive it. Keep in mind that when you file your taxes between January and April, you may encounter new tax forms.
Whew! That’s a lot to think about and perhaps you’ve added some items to your rapidly growing to-do list. Understanding your health care and coverage options can be tricky, it’s worth it to start your new life together with your health care squared away.
This post was written by Christina Cameron – health insurance navigator with MDC in Durham, North Carolina. She can be reached by email at firstname.lastname@example.org.