Married couples share a lot of things, including health insurance coverage in some cases. If you want to switch to a spouse’s policy—or your spouse wants to enroll in yours—it’s usually an easy task to accomplish. However, it’s important to get the timing right and to know when you’re eligible for special enrollment periods.
Switching to a spouse’s policy during open enrollment
If you need to switch to a spouse’s health insurance policy during an open enrollment period, changing your coverage is easy: You simply 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: Enrollment opens in the fall for coverage beginning January 1.
Note: 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 a family policy before they can participate in the HRA on a tax-free basis.
Learn how HRAs work for employees: Watch our on-demand webinar
Changing health coverage outside an open enrollment period
If you want to change your coverage to a spouse’s policy outside of the open enrollment period, things can get tricky. Businesses set their own coverage periods, and there’s no guarantee that your current policy’s coverage period will match up with the period offered by your spouse’s policy.
If the two coverage periods don’t line up, the company can refuse to cover you until open enrollment rolls around again. This can create a gap in coverage.
The following specific circumstances allow you to drop your group health insurance midyear. If you are enrolled in a section 125 cafeteria plan, and you either:
- Have your hours reduced to fewer than 30 hours per week but still retain eligibility for your company's group health policy
- Opt to buy individual health insurance through the Healthcare.gov marketplace or state ACA exchange.
Additionally, if your employer offers you a QSEHRA or an ICHRA, this triggers a Special Enrollment Period (SEP) (see below) 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
Under certain circumstances, you may qualify to switch to your spouse’s health insurance during a special enrollment period.
Special enrollment periods are triggered by certain life events, including:
- The birth (or adoption) of a child
- Loss of a spouse’s eligibility for coverage under their company’s group health insurance policy or other type of 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 a special enrollment period, you’ll probably have 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 let you enroll. You must also let your company know of your life change within a specific time frame, so don’t delay if you know you’ll 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 take a look at the summary plan description of the policy you’d like to obtain coverage from. This will list the coverage periods and qualifying events that allow you to enroll during a special enrollment period.
Are you an employer? Use our tool kit to learn how to cancel your group health plan and implement an HRA
This post was originally published April 4, 2017. It was last updated November 4, 2020.