How to switch to your spouse's health insurance policy

Are you and your legal spouse both eligible for employee health insurance benefits? If so, you should carefully review each of your company's health insurance options to determine which is best for you and your wallet. If one plan is better than the other, you may wonder if you can switch to your spouse’s policy.

Luckily, switching to your spouse’s current health insurance plan is usually simple. However, getting the timing right is crucial to ensuring you can take advantage of the plan’s open enrollment window. Outside of the benefit’s open enrollment period, you’ll need to know which circumstances allow you to enroll in the plan mid-year. This article will help point you in the right direction.

In this blog post, you’ll learn:

• The process for switching to your spouse's health insurance policy during open enrollment and mid-year.
• Circumstances that qualify for a special enrollment period.
• Key considerations when comparing your and your spouse’s health insurance options.

Switching to a spouse’s policy during their plan’s open enrollment

Changing your coverage is easy if you want to switch to a spouse’s health insurance plan during their organization’s open enrollment, and the employer doesn’t have a spousal carve-out in place. You simply cancel your current health coverage and enroll in your spouse’s policy.

If you’re making the change to cut back on group health insurance costs, timing the change during open enrollment means you can start saving right away. Most organizations align their group health plan year with the standard calendar year. Open enrollment typically begins in November for coverage starting January 1, but this can vary by company.

Suppose your spouse has an individual health insurance plan that they bought on a public or private exchange. In that case, you can enroll in the plan during the annual Open Enrollment Period. Currently, the annual enrollment period in most states typically runs from November 1 to January 15. However, new regulations from the Trump administration have led to some potential nationwide changes for 2027 enrollment¹.

Below are the quick details about the potential upcoming changes to Open Enrollment should the new regulations take effect:

• Starting the 2026 Open Enrollment Period for 2027 health coverage, the enrollment dates will begin on November 1 and end on December 15 for all states with public exchanges that use the federal Health Insurance Marketplace.
• State-based exchanges must end their annual enrollment period by December 31.
• Individuals who enroll in a health plan by December 15 and pay their first monthly premium, also known as a binder payment, will have an effective coverage date of January 1, 2027.

Changing your health insurance plan is simplest to do during the plan’s open enrollment. But there are a few other things you should know beforehand to have a successful enrollment.

Here are some tips for switching your plan during the annual enrollment period:

• Ensure that your policy and your spouse’s policy follow the same plan year and have the same effective date to avoid a gap in coverage.
• Confirm that your spouse’s plan will meet your needs regarding the preferred insurance company, covered medical services, and provider networks.
  • For example, if you or an eligible dependent child visits a specific family plan doctor, double-check that your spouse’s policy includes them in its network.

If you or your spouse’s employer is offering a stand-alone health reimbursement arrangement (HRA), keep in mind that you need specific types of health coverage to use the benefit.

For example, suppose you’re switching from group health insurance to a qualified small employer HRA (QSEHRA). In that case, you and your spouse must have a health insurance plan that meets minimum essential coverage (MEC) to participate. If your spouse has an individual family plan, you can join their policy to take advantage of the QSEHRA and receive tax-free reimbursements for insurance premiums and qualified out-of-pocket medical costs.

Those participating in the individual coverage HRA (ICHRA) must have a qualifying form of individual health insurance. This means you’ll need to switch to an eligible health policy, such as an ACA-compliant individual plan on a public or private marketplace. Medicare Parts A and B, Medicare Part C, or a catastrophic health plan (if you and your spouse qualify) are also acceptable coverage options.

Spousal carve-outs and surcharges

Before switching to your spouse’s health insurance policy, it’s essential to check whether their employer has a spousal carve-out or spousal surcharge in place.

A spousal carve-out is an optional rule that prevents an employee from enrolling their spouse in the group health plan if the spouse has access to health coverage through their own employer. In these cases, even if your spouse’s plan is a good fit, you may not be eligible to join it.

Even if your spouse’s employer allows you to join their health plan, they may apply a spousal surcharge. This means that you can enroll in the plan, but at a higher monthly premium rate.

Before deciding to switch, consider the following:

• Review your spouse’s insurance plan documents or summary plan description.
• Confirm with their employer whether a spousal carve-out or surcharge applies.
• If a surcharge applies, compare the added cost to staying on your existing plan.

Changing health coverage outside the plan’s open enrollment

Changing your coverage to a spouse’s policy outside of the plan’s open enrollment period can be a difficult process. Your current policy’s coverage period may not match your spouse’s plan period. In this case, your spouse’s company may refuse to add you to the plan until the next open enrollment period.

If you don’t pay your monthly premiums on a pre-tax basis, you can cancel your employer group plan coverage anytime. But if you do make pre-tax premium payments, that means the federal government considers your employer’s plan to be a cafeteria plan. Therefore, you typically must have a “change in election” life event to trigger a special enrollment period and make a change mid-year. But we’ll go into more detail about that later.

If you have a cafeteria plan, there are two other instances where you can make changes mid-year:

• Your employer reduces your work hours to fewer than 30 hours per week.
• You qualify for a special enrollment period and plan to buy a qualified health plan on a public exchange.

Special enrollment periods for individual coverage

A special enrollment period allows you to enroll in individual health coverage outside of the annual Open Enrollment Period. If you experience one of several specific life events, you may qualify to switch to your spouse’s current individual health insurance coverage during a special enrollment period.

Generally speaking, you'll have 60 days after the qualifying event to enroll in a new type of coverage.

Certain qualifying events trigger special enrollment periods, including:

• A change in household size. This includes getting married, the birth of biological children (or the addition of adopted or foster children), divorce, or legal separation.
• A change in your primary place of residence, such as moving to a new home in a different ZIP code or county.
• The loss of employer-sponsored health insurance.
• Your spouse’s company stops making contributions toward their health coverage.
• Your spouse loses Medicaid coverage eligibility.
• Your spouse no longer has access to the Children’s Health Insurance Program (CHIP) coverage.
• Your spouse meets the eligibility requirements for federal health insurance premium assistance under the Medicaid or CHIP programs.
• When your employer offers you a QSEHRA or an ICHRA.

Suppose you qualify for a special enrollment period. In that case, you must show your insurance carrier (and sometimes your employer’s plan administrator) acceptable proof of your change in circumstances, such as marriage certificates, annulment documents, or a child’s birth certificate.

Completing this verification process as quickly as possible is essential. If you don’t submit proof within 30 days, your company may cancel your health plan selection. If this happens, you can reapply for the special enrollment period and restart the verification process. But you can only do so if your qualifying event was less than 60 days ago. So, don’t delay if you need to switch coverage outside your plan’s open enrollment period.

Conclusion

If you’d like to drop your current plan and switch to your spouse’s policy, review each coverage option to find out which policy is right for your specific circumstances. You can typically switch health insurance coverage during the annual open enrollment window. However, you may be eligible for a special enrollment period if you have a qualifying life event.

Choosing the best insurance company and health plan requires thorough research and time. Before you get started, be sure to review all the potential expenses of switching policies, as extra fees could cancel out any financial benefits of making a transition. Although it may seem like a lot of work initially, it’s worth making the effort to ensure you make the right decision for you and your family.

This post was originally published on November 4, 2020. It was last updated on December 29, 2025.

References

1. Patient Protection and Affordable Care Act; Marketplace Integrity and Affordability