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 explore each of your company's health insurance options to see 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 plan is usually simple. But getting the timing right is essential to ensure you can take advantage of the plan’s open enrollment. Outside of the plan’s open enrollment period, you’ll need to know which circumstances allow you to enroll in the plan mid-year.

In this blog post, you’ll learn:

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

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 plan during their organization’s open enrollment. 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 plan costs, timing the change during open enrollment means you can start saving right away. Most organizations align their group health insurance plan year with the calendar year. Open enrollment generally begins in November for coverage starting January 1, but it can differ by company.

If your spouse has an individual health plan from the Health Insurance Marketplaces, you can enroll in the plan during the annual Open Enrollment Period. This begins on November 1 in most states. If you enroll by December 15 and pay your first month’s premium, your coverage will become active starting January 1.

Here are some other 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 policy will meet your needs regarding covered medical services, available providers, and any health conditions.
  • For example, if you or an eligible dependent child visit a specific family doctor, double-check that your spouse’s policy includes them in its network.

Suppose you’re switching from group health insurance to a qualified small employer health reimbursement arrangement (QSEHRA). In that case, your spouse must have a health insurance plan that meets minimum essential coverage (MEC) to participate in the benefit. A QSEHRA allows employees to receive tax-free reimbursements for insurance premiums and other qualified out-of-pocket 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 a plan on the Marketplaces.

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 open enrollment¹.

If you don’t pay your monthly premiums on a pre-tax basis, you can cancel your group plan coverage anytime. But if you do, your employer-sponsored health coverage is a cafeteria plan. Therefore, you typically must have a “change in election” life event to make a change mid-year.

This is because such life events trigger a special enrollment period. 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 (special enrollment period) and plan to buy a qualified health plan on a public exchange.

Special enrollment periods

A special enrollment period lets you enroll in health coverage outside the annual open enrollment period. Under specific circumstances, you may qualify to switch to your spouse’s current health insurance coverage during a special enrollment period.

Generally speaking, you'll have a 60-day special enrollment period after the event to enroll in a new type of coverage.

Certain qualifying life events trigger special enrollment periods, including:

• Changes in household size, such as marriages, birth (or adoption) of a child, or divorce
• Change in your primary place of residence, such as moving to a new home in a new ZIP code or county
• Loss of employer-sponsored health insurance
• Your spouse’s company stops making contributions toward their health coverage
• Your spouse loses Medicaid eligibility
• Your spouse no longer has access to Children’s Health Insurance Program (CHIP) coverage
• Your spouse meets the eligibility requirements for 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 company acceptable proof of your change in circumstances, such as a marriage certificate, annulment document, or 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.

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.

Conclusion

If you’d like to drop your current plan and switch to your spouse’s policy, review each coverage option to determine which policy works best for you. You can typically switch health insurance plans during open enrollment, but you may be eligible for a special enrollment period if you have a qualifying life event.

Picking the best insurance provider and health plan can take some research. Reviewing all potential expenses of switching policies is vital, as extra fees could cancel potential savings on medical costs. But it’s worth making the team 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 November 11, 2024.