Special Enrollment Options After Marriage and Divorce

When you get married or divorced, you qualify for a special enrollment period to adjust your health insurance. Learn how to navigate this and avoid coverage gaps through SelfGood.

Life changes like marriage or divorce affect more than just your personal life; they also impact your health insurance. These events trigger a Special Enrollment Period (SEP), allowing you to update your health coverage outside the typical Open Enrollment window. Understanding these options ensures you avoid coverage gaps.

Key Takeaways:

• Marriage and divorce trigger a 60-day Special Enrollment Period (SEP) for health insurance.
• You can add a spouse to your plan, combine policies, or enroll in individual coverage.
• COBRA is an option after divorce, but marketplace plans might offer more affordable alternatives.

What Is a Special Enrollment Period?

A Special Enrollment Period (SEP) allows you to change or enroll in health insurance outside of the annual Open Enrollment period if you experience a Qualifying Life Event (QLE). Major life events like marriage, divorce, childbirth, or job loss qualify you for an SEP.

For example, if you get married, you can add your spouse to your health insurance plan or opt for a new policy that better fits your combined needs. Divorce, on the other hand, may leave the non-policyholder spouse without coverage, prompting them to seek individual plans or other options like COBRA.

To use an SEP, you must act within a specific timeframe. In most cases, you have 60 days from the date of the event to adjust your coverage. If you miss this window, you may have to wait until the next Open Enrollment period, potentially leaving you or your spouse without coverage.

Why Does Marriage Affect Health Insurance?

Marriage is a Qualifying Life Event (QLE) because it changes your household composition. Adding a spouse to your household means you have the option to adjust your health insurance coverage. Many couples opt to combine their policies to save money, but it’s important to know that not all employers offer spousal coverage.

Some employers have policies that restrict spousal coverage if the spouse has access to their own employer-sponsored plan. This is why it’s essential to review both partners’ plans before deciding whether to combine coverage.

How to Enroll in Health Insurance After Marriage

When you get married, you’ll need to determine whether to add your spouse to your existing plan, combine your policies, or enroll in a new one. Here’s a step-by-step guide to help you navigate this process:

1. Review both spouses’ current coverage: Compare the benefits of both plans, including deductibles, premiums, and out-of-pocket maximums.
2. Decide whether to combine plans or stay separate: Consider whether combining will save you money or provide better coverage.
3. Take action within the SEP window: Remember, you have 60 days after marriage to make any changes to your health insurance.

This SEP window is critical. Missing it could result in a gap in coverage, forcing you to wait for the next Open Enrollment period.

Should You and Your Spouse Combine Insurance? Pros and Cons

Choosing whether to combine insurance plans depends on several factors, including costs, benefits, and convenience. Let’s explore the pros and cons:

Pros:

• Cost-saving: Combining plans can reduce premiums and deductibles, especially if one employer offers strong coverage for spouses.
• Simplified management: Having one plan can simplify billing and claim management for couples.

Cons:

• Employer limitations: Some employers do not allow spouses to join their plan if they have their own employer-sponsored coverage.
• Premium costs: Some plans charge higher premiums for spousal coverage, which may not make combining plans financially worthwhile.

Before deciding, evaluate each spouse’s health needs. If one partner requires more comprehensive coverage, staying on separate plans might be the better choice.

Things to Consider When Choosing a Plan After Marriage

When selecting a plan after marriage, here are a few key factors to consider:

• Health needs: Do you both have similar health needs, or does one spouse need more coverage due to chronic conditions? This can influence whether you combine plans or stick to individual ones.
• Network coverage: Ensure that your preferred healthcare providers are within the network of any new plan.
• Costs: Compare premiums, deductibles, and out-of-pocket maximums across both plans. Budgeting for healthcare expenses is crucial, especially in a marriage.

Divorce and Health Insurance Special Enrollment Options

Just like marriage, divorce qualifies as a Qualifying Life Event (QLE), triggering an SEP14. After a divorce, the non-policyholder spouse typically loses access to the other spouse’s health insurance plan. It’s important to act quickly and explore your options during the SEP.

Steps to Secure Health Insurance After Divorce

If your health insurance is tied to your spouse’s plan, you’ll need to secure new coverage after a divorce. Here are your main options:

1. COBRA: This federal program allows you to retain your spouse’s health insurance for up to 36 months, but it can be costly since you’re responsible for the full premium.
2. Marketplace Plan: Enrolling in a Marketplace plan may be more affordable, especially if you qualify for income-based subsidies.
3. Medicaid: Depending on your income after divorce, Medicaid may be an option to ensure coverage.

COBRA vs. Marketplace: Which Is Better After Divorce?

While COBRA provides continuity, it often comes with high premiums since you are responsible for both the employee and employer portion of the insurance. For those on a tighter budget, enrolling in a Marketplace plan might be more practical. Marketplace plans often come with financial subsidies, which can lower your monthly premium significantly.

Timeframes and Deadlines for Health Insurance Post-Divorce

It’s critical to act within the 60-day window following a divorce to enroll in a new health plan4. Failing to secure coverage within this SEP could leave you without insurance until the next Open Enrollment period.

Legal Separation: Similarities and Differences from Divorce

Legal separation is treated similarly to divorce in terms of health insurance. In most cases, a legal separation qualifies for SEP, allowing you to update your coverage. However, state laws and insurance policies vary, so it’s essential to check with your insurance provider to confirm your eligibility.

Final Thoughts

Whether you’re getting married or divorced, changes in marital status have a significant impact on your health insurance. Utilizing the Special Enrollment Period is crucial for maintaining continuous coverage. Be proactive, review your options carefully, and act within the 60-day SEP window to avoid coverage gaps. Whether it’s combining plans with a new spouse or securing individual coverage post-divorce, taking the right steps will ensure your health needs are met.

Frequently Asked Questions

How long do I have to change my health insurance after marriage or divorce?

You have 60 days from the date of your marriage or divorce to change your health insurance plan.

Can I stay on my spouse’s plan after divorce?

Yes, temporarily through COBRA, but it’s often expensive. You may want to explore more affordable individual options like a Marketplace plan.

What if I miss the SEP deadline?

If you miss the 60-day SEP window, you may still qualify for Medicaid or other options available outside the Open Enrollment period.

Sources:

1. HealthPartners. “Qualifying Life Events for Special Enrollment.” www.healthpartners.com
2. UnitedHealthcare. “Getting Married Changes Health Insurance.” www.uhc.com
3. U.S. Department of Labor. “COBRA Health Insurance Information.” www.dol.gov