Q. I recently got married and my spouse is self-employed. Can we combine our health insurance plans, or should we each maintain separate coverage? What are the pros and cons of each option, especially considering our differing employment statuses.
Combining health insurance plans as a married couple, especially when one spouse is self-employed, involves weighing the pros and cons of different options. Here are some considerations to help you decide whether to combine your health insurance or maintain separate coverage:
Combining health insurance plans
Pros
Cost savings:Â Combining health insurance may result in cost savings compared to maintaining two separate plans. Family or couple coverage often comes with more favourable premium rates than individual plans.
Comprehensive coverage:Â Family health insurance plans generally provide comprehensive coverage for both spouses, ensuring that a wider range of medical expenses is covered.
Coordination of benefits:Â Combining plans can simplify the coordination of benefits, making it easier to manage and process claims for medical expenses.
Cons
Limited options: Combining plans means you may have to choose from the available options offered by one insurer. This could limit your ability to select plans that individually cater to your specific needs.
Dependence on one employer/provider:Â If one spouse’s employer provides the health insurance, the other spouse becomes dependent on that employer for coverage. Self-employed individuals may not have access to employer-sponsored plans.
Potential loss of coverage for the self-employed spouse:Â If the self-employed spouse loses their business or decides to discontinue the plan, it could leave the couple without coverage. This may be a risk if the self-employed spouse’s income is unstable.
Maintaining separate health insurance plans
Pros
Flexibility: Each spouse can choose a health insurance plan that best suits their individual needs, preferences, and budget. This allows for more flexibility in tailoring coverage.
Independence:Â Each spouse is not dependent on the other’s employer or business for health insurance coverage. This can be advantageous if one spouse experiences changes in employment or self-employment status.
Diverse provider networks:Â Maintaining separate plans allows each spouse to access different provider networks, potentially providing a broader choice of healthcare providers.
Cons
Potentially higher costs:Â Maintaining separate health insurance plans may result in higher overall premium costs compared to a family plan. This depends on the specific plans chosen and their respective costs.
Coordination challenges:Â Managing and coordinating benefits between two separate plans can be more complex, potentially leading to confusion and administrative challenges.
Overlapping coverage:Â There might be some overlap in coverage areas, leading to unnecessary duplication of benefits and costs.
Ultimately, the decision to combine or maintain separate health insurance plans depends on your specific circumstances, preferences, and the available options. It’s advisable to carefully compare the costs, coverage, and flexibility of different plans and consider factors such as stability in employment or self-employment. Additionally, consulting with a health insurance advisor can provide personalised guidance based on your unique situation.
