If you and your spouse are both eligible for employee health benefits, you may want to explore each company's health insurance options to see which is best for you and your wallet.
If you want to switch to a spouse’s policy, or your spouse wants to enroll in yours, it’s usually a simple task to accomplish. However, it’s important to get the timing right and to know when you’re eligible for special enrollment periods (SEPs).
By taking the time to figure out which plan is best, you can save money and hassle. In this article, we’ll go over how to switch to a spouse’s policy during and outside open enrollment and what circumstances can trigger a SEP.
Switching to a spouse’s policy during open enrollment
If you want to switch to a spouse’s health insurance policy during the annual open enrollment period, changing your coverage is easy. You simply need to cancel your current 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 start saving right away.
Most organizations run their coverage with the calendar year. Open enrollment generally begins in November for coverage beginning January 1. Be sure to check that you and your spouse’s plans follow the same plan year with the same start date for changes made during open enrollment to avoid a gap in coverage.
If you’re switching from group health insurance to a qualified small employer health reimbursement arrangement (QSEHRA) or an individual coverage HRA (ICHRA), your spouse must be enrolled in an individual or family policy before they can participate in the HRA on a tax-free basis.
Changing health coverage outside an open enrollment period
It can be tricky to change your coverage to a spouse’s policy outside of the open enrollment period. Your current policy’s coverage period may not match up with your spouse’s policy coverage period and you could be refused coverage until open enrollment rolls around again.
If you are enrolled in a cafeteria plan and have had your hours reduced to 30 hours per week or less, or if you’ve purchased an individual health insurance plan through the federal Marketplace or state ACA exchange, among other specific instances, you’re able to drop your group health insurance midyear.
Additionally, if your employer offers you a QSEHRA or an ICHRA, this triggers a special enrollment period (SEP), giving you 60 days from the time you are offered the HRA to change to your spouse's individual insurance family plan.
Special enrollment periods
An SEP lets you enroll in health coverage outside of the annual open enrollment period. Under specific circumstances, you may qualify to switch to your spouse’s health insurance during an SEP.
Special enrollment periods are triggered by certain life events, including:
- Changes in household size such as marriages, birth (or adoption) oh a child, or divorce
- Change in primary place of residence
- Loss of health insurance coverage, typically due to job loss
- When a spouse’s company stops making contributions toward their health coverage
- When a spouse loses Medicaid eligibility, is no longer eligible for coverage under a state Children’s Health Insurance Program (CHIP), or becomes eligible for premium assistance for group health insurance under those programs
- When your employer offers you a QSEHRA or an ICHRA
If you qualify for an SEP, you’ll need to show your company proof of your change in circumstances—such as a marriage certificate or your child’s birth certificate—before the company will consider you qualified.
It’s important to complete this verification process as quickly as possible. If you don’t submit proof within 30 days, your plan selection may be cancelled. You can reapply for the SEP and restart the verification process only if your qualifying event was less than 60 days ago, so don’t delay if you need to switch coverage outside open enrollment.
If you’d like to drop your current health coverage and switch to your spouse’s policy, or vice versa, your first step should be to review each policy carefully so you and your spouse can choose the coverage that works best for you. You’re typically able to switch plans during open enrollment, but you may be eligible for an SEP if you have a qualifying life event.
It’s important to review all potential costs involved in switching insurance policies because additional fees could cancel out any potential savings. Picking the best option can take some research, so it’s critical to take your time so you can make the right decision for you and your family.
This post was originally published November 4, 2020. It was last updated October 18, 2021.