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Carla Fried - Headshots

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Healthcare

Your healthcare needs vary at different stages of your life, so it's no surprise that those costs will change. But what are those specific life changes you should look out for? We discuss key life events that can change the cost of your healthcare.

Life Events That Can Change Your Healthcare Costs

HSA Account Rules

Lauren Hargrave is a writer from San Francisco who focuses on technology, finance and wellness. She follows comedians like most people follow bands and believes an outdoor sweat session can cure almost any bad mood. She’s also been writing her first novel for so long, her mom doesn’t ask about it anymore.

Lauren Hargrave

Employee Benefits

Marriage

Carla specializes in service journalism for news outlets including The New York Times, Money magazine, and CNBC.com. For the past 15 years she has writen for traditional news outlets, ghostwriting books and articles for clients, creating content for major financial service firms, and editing investment newsletters and white papers.  

Her work appears in The New York Times, Money Magazine, Barron's and Consumer Reports.

Carla Fried

Health Insurance

Personal Finance

Kate Dore is a Nashville-based freelance personal finance writer and Candidate for Certified Financial Planner™ Certification. She teaches financial literacy with Junior Achievement and serves as Director of Public Relations for the Financial Planning Association of Middle Tennessee. Her work has been published in Business Insider, Financial Planning Magazine, and Simple Money Magazine.

Getting married is an exciting endeavor, but before you say I do, there are some serious financial discussions you should have with your partner.

8 Financial Discussions to Have Before Marriage

Adding your partner to your health insurance plan can cause your premiums to spike. Here’s what you need to know.

Average Cost of Health Insurance for a Married Couple

There are some technicalities that go along with getting married - and adding your spouse to your health care plan may be one of them. But can you use money that you saved up before you got married on your spouse?

Can I use my HSA for my spouse?

Financial Health

Benefits

just had a baby or adopted?

am married or getting married?

If you have an HSA, you know there are many technicalities that come with your account. How can getting married change how your HSA works?

How does getting married affect my HSA?

Healthcare Benefits

Vicky Warren, once a nurse, now a freelance healthcare writer and social media coach.

Vicky Warren

When you and your partner decide to tie the knot, there are a few other decisions that need to be made - such as deciding on what to do for healthcare. We detail considerations you'll need to take when choosing a healthcare plan here. 

Average Health Insurance Costs for a Newly Married Couple in 2020

Employee Health Insurance

Ben is a Freelance Content Specialist who specializes in personal finance and travel. Ben’s work can be seen in publications such as NerdWallet, Experian, Wirecutter, Credit Karma, and Bank Rate. When he’s not writing, you can find him trying new foods, hiking, and spending time with his kids.

Ben Luthi

HSA (Health Savings Account)

have children?

__Editor's Note:__ This article has been edited to include more accurate and relevant information. This piece was originally posted on February 13, 2019. 

---

You might have heard someone joke about getting married for the tax benefits and think marriage would make everything, including health insurance, cheaper. Unfortunately, that’s not always true. 

As a married couple, the cost of health insurance will largely depend on the type of insurance plan you have, who’s covered, where you got it, and, in some cases, your income level.

## 3 Health Insurance Scenarios for Married Couples

The cost of health insurance plans depend on a few different factors. Here are some of the situations you may find yourself in:

- You both have employer-sponsored health insurance
- One of you has employer-sponsored health insurance
- Neither of you has employer-sponsored health insurance

It’s also important to remember that the more people on your plan, the pricier it will be. So if you’re married with children, expect a higher premium to cover everyone in the family.

### You Both Have Employer-Sponsored Health Insurance

If you’re both employed by a company or companies that contribute to your health insurance premiums, maintaining your individual coverage with your respective employers is almost always the cheapest way to go. 

That’s because employers typically require very low contributions from their employees to the plan cost — even if it feels like a lot coming out of your paycheck. According to the [Kaiser Family Foundation](https://www.kff.org/report-section/ehbs-2020-summary-of-findings/) (KFF), employees pay only 17% of the premiums on individual plans on average, which you can do if you both have that option, and 27% on family plans. 

In 2020, that breaks down the average health insurance costs you can expect to pay for an individual or family plan:

![chart 8](//images.ctfassets.net/6j8y907dne6i/31zxbpAt1QpFXJvTjkdTRR/04db72d96181b4f998887e657131e8a1/chart_8.svg)

Again, the cost of a family plan may vary depending on how many people you’re adding to the plan. Also, it’s important to note that the cost of your premium will also depend on where you’re located and the amount to which your employer is able and willing to contribute to your health insurance costs.

In some cases, an employer may pay the full amount, but most employees can pay at least some of the cost. 

Speak with your human resources representative about how much it would cost to combine health insurance coverage with your partner into a single plan, and have your spouse do the same. Note that you can add your spouse to your plan within 60 days of getting married. Otherwise, you’d need to wait until open enrollment.

Then, compare the price increases to what you’d end up paying individually. Also, consider the amount of coverage you’re getting with each plan. While one may be much cheaper, you may end up paying more out of pocket on health care expenses throughout the year before you hit your deductible.

Finally, family deductibles are typically double the deductible for individuals or more. If your plan has a separate deductible for each person on the policy, it won’t make much of a difference. But if you have to reach the family deductible before your insurance company starts helping with the costs, it may be better to maintain separate health insurance plans. 

### One of You has Employer-Sponsored Health Insurance

If only one of you has employer-sponsored health insurance, the situation may sound similar to the one above, but it’s not entirely. 

Again, adding your partner to your plan may more than double, triple, or even quadruple the cost of your coverage, based on KFF’s data. Also, remember the other factors that go into determining your premiums, including:

- The type of coverage
- The plan benefits (silver plans, platinum plans, etc.)
- Your employer’s contribution
- Where you live

If only one of you has employer-sponsored health insurance and that employer doesn’t contribute to the cost of dependents, buying the family coverage through the employer-sponsored plan might still be worth it. 

That’s because employers can actually negotiate better rates with health insurance providers with group policies, something an individual can’t do. So the premium you’ll pay for each individual added to the plan could be cheaper than what you’d find out in the marketplace for the same level of coverage. 

You’ll also get the added benefit of paying for the premium pre-income tax, therefore lowering your overall income tax liability. If you pay for a marketplace plan with after-tax dollars, you can only deduct them on your taxes if you itemize your deductions, and even then, there are limits on what you can include.

### Neither of You Has Employer-Sponsored Health Insurance

If you’re both self-employed or don’t have an employer that offers health insurance as a benefit, your only option to get coverage is through the [Affordable Care Act (ACA) Marketplace](https://www.healthcare.gov/).

As with pricing for employer-sponsored plans, the cost of health insurance on a marketplace plan partly depends on your location, how many people are covered, the type of coverage, and the benefits the plan offers. The biggest difference is that there’s no employer to contribute to the plan costs, which means you’re on your own.

The ACA compensates for this with the premium tax credit. This refundable tax credit is available to low-income individuals and families who typically have a difficult time paying for health insurance on their own. 

To qualify, your household income must be between 100% and 400% of the federal poverty level based on your family size. If you’re eligible, you may choose to get some or all of the premium tax credit paid in advance, which reduces your out-of-pocket costs for monthly premiums. Otherwise, you’ll pay the full premium each month and get the full credit when you file your taxes for the year.

In 2020, the average costs per month for an individual marketplace plan was $456, according to [eHealth](https://news.ehealthinsurance.com/_ir/68/20205/eHealth_2020_ACA_Index_Report_Unsubsidized_Consumers.pdf). For families, that cost more than doubles to $1,152. To get an estimate of marketplace health insurance costs in your area, including subsidies, check out the [KFF Health Insurance Calculator](https://www.kff.org/interactive/subsidy-calculator/).

Depending on the plans available in your area, it might be cheaper to get coverage individually than as a family unit.

## The Bottom Line

When you get married, you often start to think of yourselves as a family. But whether or not it makes sense to buy health insurance as a family will depend largely on your individual situation. That’s especially the case if there are no children to consider yet.

It may make sense to combine checking and savings accounts, but think twice before you do the same for health insurance. Because health insurance can be a costly line-item in any budget, even if it’s an employer-sponsored plan, take the time to explore all of your options before making a decision.


How Much Married Couples Pay for Health Insurance

There are many big decisions to make as newlyweds. As you combine lives, you will have to make choices about your home, finances, and your family. You will also have to plan for healthcare—including your health insurance options. There are several things to consider before signing up for a plan, though. Here's what you and your new family need to know to make the right choices. 

## How to choose a health insurance plan

Once you get married, you will have to make some tough decisions about health insurance. You will have three options to choose from: keeping separate health insurance plans, joining your spouse’s plan, or having your spouse join your plan. 

The problem is, not all companies allow spouses to join their employer sponsored healthcare plan. A [2016 study from Mercer](https://www.mercer.com/newsroom/national-survey-of-employer-sponsored-health-plans-2016.html) found 11% of large employers exclude spouses who may have access to another health insurance plan. For companies that allow it, you may see a spousal surcharge, which is usually about $100 per month, according to the study.

You will also have to consider enrollment periods. Getting married is considered a [qualified life event](https://livelyme.com/life-events-that-can-change-your-healthcare-costs) that may trigger a special enrollment period. These periods give you 60 days to sign up for a private health insurance plan or 30 days to enroll in an employer's plan. To qualify for a [special enrollment period](https://www.healthcare.gov/glossary/special-enrollment-period/), though, you may have to show proof of a life event—like your marriage certificate.

For single coverage, the average annual premium was $7,188 in 2019, according to the [Kaiser Family Foundation](https://www.kff.org/report-section/ehbs-2019-section-1-cost-of-health-insurance/). Joining the same health insurance plan may be more affordable. But you will need to compare premiums, deductibles, coinsurance, and copayments to find out.

One benefit of joining the same health insurance plan is you may meet the plan’s deductible faster, which could mean fewer out-of-pocket expenses for the year.

## When to consider a family plan

As your family grows—either from combining health care plans with your partner or planning to have children—the cost of health insurance will increase. Last year, the average family paid $20,576 for health insurance premiums, according to the [Kaiser Family Foundation](https://www.kff.org/report-section/ehbs-2019-section-1-cost-of-health-insurance/). The report says premiums have increased by 22% since 2014.

That's a massive financial burden for any family. But you should consider the plan’s full out-of-pocket maximum costs before making a decision. Depending on your deductible, your family could pay a lot more—or a lot less—on out-of-pocket medical expenses. You should also look at co-payments, co-insurance, and see which providers the plan includes.

If you choose a high-deductible health insurance plan, you can see if you can pair it with a [health savings account (HSA)](https://livelyme.com/hsa-guide). These accounts allow you to save pre-tax dollars for qualified medical expenses. Your employer also may offer a flexible spending arrangement (FSA), which could also cut back on out-of-pocket costs.

## Don't wait on health insurance decisions

As newlyweds, it may be more exciting to plan things like trips and dinner parties. But you shouldn't push your family's health insurance to the back burner. By procrastinating, you could miss a key deadline, which could leave you with a gap in health coverage. The sooner you start comparing options, the easier—and faster—the decision will be. 

We experience many stages in life and each phase can affect healthcare costs. From turning 26 to retirement, it’s important to know your healthcare coverage options.  

Let’s discuss some of the big life events that can change your healthcare costs. 

## Turning 26
Under the Affordable Care Act (ACA), young adults are allowed to stay on their parents health plan until they turn 26. They can be on the plan even if they don’t live with their parents - like when they go to college. In addition, if they get married and have children, they may be eligible to stay on the plan until age 26. 
 
Once those 26 candles are blown out, young adults must obtain their own coverage. If you’re about to age out of your parent’s health plan, it’s time to figure out options. There are several ways to get insured, from enrolling in your employer's healthcare plan to purchasing insurance through the [marketplace](https://www.healthcare.gov/). Your 26th birthday allows you to purchase insurance during a Special Enrollment Period (SEP). The period lasts for 120 days, from 60 days prior to your 26th birthday to 60 days after. 

## Marriage
Getting married is considered a Qualifying Life Event (QLE). You and your spouse - and any children you may have - can receive or change health care coverage as soon as you’re married.   

While choosing health insurance isn’t the most exciting part of planning a life together, it’s worth taking time to carefully consider. 

## Divorce
If you have your own health coverage and get divorced, you can keep the current plan you have. If you are covered under your spouse’s plan, you may no longer be eligible as a dependent - depending on your state law. You may also be able to negotiate keeping your spouse’s healthcare during the negotiation process. 

If you are no longer eligible to stay on your spouse’s plan after the divorce, there are a few options you can take. You can sign up for an employer sponsored health plan, buy a plan from the marketplace or health insurance company, or use COBRA to keep the coverage you had while on your spouse’s plan. 

## Having or Adopting Children

#### Having a Baby

Health Insurance Marketplace and Medicaid plans cover pregnancy and childbirth - even if you become pregnant before coverage begins. 

Having a baby is a QLE, so you can enroll or change your health care coverage. If you enroll in a new plan, coverage can be effective from the day your baby is born. If you already have Marketplace coverage, you have two options: you can add your child to your current plan or change to a different plan that better fits your needs.

#### Adopting a Child

When you adopt a child, your health insurance provider is legally required to cover them as they would a biological child. Adoption is a QLE and you can add your child to your insurance plan once the adoption is complete.

The [Health Insurance Portability and Accountability Act of 1996 (HIPAA)](https://www.dhcs.ca.gov/formsandpubs/laws/hipaa/Pages/1.00WhatisHIPAA.aspx) prevents insurance companies from denying an adopted child coverage based on any preexisting conditions as long as the parents request enrollment within 30 days of placement.

## Retirement

Retirement is another stage of life that requires careful planning and forethought. If you previously had a job with health insurance, learn about the options you may have throughout retirement. Can you continue with your existing group plan? Would you be eligible to keep your current benefits through COBRA? These are the kind of questions you should ask your HR representative at your company as you’re preparing for retirement. 

If you’re retiring before 65, you cannot be denied coverage for pre-existing conditions, thanks to the Affordable Care Act. However, you may pay up to $1,000 a month for premiums between the ages of 55 and 64 for healthcare coverage.  
 
Once you turn 65, you can apply for Medicare. Once on Medicare, you’ll have options. Will you choose original Medicare or a Medicare Advantage Plan? There are pro’s and con’s to both to think about. The best place to get information is on [Medicare.gov](https://www.medicare.gov/). You may still want professional help to decide, so plan to talk with an agent for the most in depth information. 
 
Each stage of life brings new decisions to make to have the best healthcare coverage for our situation. Take time to learn your options for the stage of life you’re in. 





If you are married, you will be able to use your HSA to pay for a spouse’s medical expenses.

Here are a few key rules:

## Your spouse does not need to be covered on your High Deductible Health Plan (HDHP).

While the amount you can contribute to your HSA is determined by whether you have single-only or family coverage, there are no limitations on using money in your HSA to pay for a spouse’s unreimbursed medical expenses.

If your spouse has other health insurance coverage you can still make tax-free withdrawals from your HSA to cover that spouse’s [qualified medical expenses](https://livelyme.com/whats-eligible/), as long as your spouse was not reimbursed by his/her insurance policy.

## You can use money saved before you were married to pay for current medical expenses of your spouse. 

You can’t use your HSA to pay for a spouse’s medical expenses that occurred before you were married. 

But once you are married you can use money in your HSA to cover current medical expenses of a spouse, even if your HSA contributions occurred prior to your marriage. For example, let’s say you have been saving in an HSA since 2015, and were married in August 2019. The entire balance of your HSA can be used to pay for medical expenses your spouse incurred after your August 2019 marriage.

Your spouse does not need to be covered by your HDHP for you to be able to make tax-free withdrawals for qualified medical expenses. 

When you’re getting married, the issue of what happens to your Health Savings Account (HSA) is not exactly top of mind. With the whirlwind of celebrations and planning going on around you, this is completely understandable.

But soon after the festivities, you should take a fresh spin through how your health care insurance decisions as a married couple change your eligibility for an HSA. If you remain eligible, you will be able to contribute more into a family account for the future.

If you are looking to contribute more into a family HSA, be aware that the IRS determines eligibility and contribution limits once you are married differently than when you were a single tax-payer. Consult a tax professional or your HSA administrator to see how this affects your contribution limits.

Here are common scenarios that we’ve seen happen with HSAs after two individuals get married:

## One spouse has an HDHP with an HSA and the other spouse will join that coverage.

When you change the coverage in your high deductible health insurance plan (HDHP) from single to family, the annual contribution limit changes from $3,500 to $7,000. That’s $7,000 combined for both of you. In 2020 the contribution limits will rise to $3,550 and $7,100. Anyone at least 55 years old can contribute an additional $1,000. If you are both 55 or older, you can add a total of $2,000 more to your contribution.

Your total contribution in the year you get married must be adjusted (pro-rated is the technical term) to account for the months you were single and the months you were married.

For example, let’s say a couple—both younger than 55 -- married in August. The spouse with the HSA thus will have 7 months under single coverage and 5 months with married coverage.

Here’s how to calculate this:

__Step 1__: Multiply the months under single coverage by $3,500:     _____

__Step 2__: Multiply the months under married/family coverage by $7,000    _____

__Step 3__: Add the sums from Step 1 and Step 2 and divide by 12: ______
Voila: That’s now your combined maximum contribution for the year.

Using our August example: 
7 months x $3,500 = $24,500 
5 months x $7,000 = $35,000

Total = $59,500; Divided by 12 = $4,958.

The $4,958 is the prorated contribution max for our couple that was married in August. The following year they are eligible to contribute the maximum. In 2020 that will be $7,100.

## You both have your own HDHPS with HSAs and intend to keep separate coverage.

Some employers insist that working spouses who are eligible for coverage through their employer use that coverage, rather than join their spouse’s plan. If that’s the case, you can both keep contributing to your separate HSAs, but your combined annual max is $7,000 in 2019, not $14,000.

## You have an HDHP/HSA, but your spouse keeps non-HDHP coverage.

If you are covered by your spouse’s non-HDHP plan you lose the right to contribute to an HSA. If you aren’t covered by a spouse’s non-HDHP plan, you can keep contributing to your HSA if your remain covered by an HDHP. If your HDHP just covers you, you can only contribute the single-coverage maximum ($3,500 in 2019), even though you are married. Money in your HSA can be used to pay for qualified health care expenses for you and your spouse. 

## You switch to a health insurance plan that is not an HDHP that covers both of you.

You can’t make any more contributions to your HSA for the year, but you can use the money in your HSA to cover qualified expenses for your spouse. You can choose to invest the money or use it for qualified medical expenses, but you are no longer eligible to contribute.




Engaged? Congratulations! You’re on your way to wedded bliss. Or are you? Of the top ten things couples fight about, money is one of the most common and can be the hardest to reconcile because it touches every aspect of your life. Even if you’ve already lived together for a while, these are the eight financial discussions you absolutely should have before you put rings on those fingers.

## Discussion #1 - Debt

*Who currently has what debt?  How do you feel about taking on joint debt?* 

In most states, the debt you incur before getting married doesn’t become joint debt in name.  But if your spouse declares bankruptcy because of said debt, the creditors can come after your joint assets, which means it can become your problem too. Also, if you open a joint checking or credit account, you’re also liable for what your spouse spends on said account. So before you get married, have a discussion about your collective debt. Yours, theirs, yours and theirs, and then put together a game plan to pay it off.  

Having too much outstanding debt can hurt your credit which can, in turn, limit large future financial decisions, like purchasing a home.  Which brings us to discussion number two.

## Discussion #2 - Credit

*What are your credit scores?  What are the actions you can take to improve them?*

Your credit score affects your financial freedom, so if you or your spouse has a score of 700 or above, you want to maintain that score. If you or your spouse has a score below that, you want to focus on improving it. The better your credit score, the less it costs you to borrow money, which could mean big savings if you plan to buy a house, a car or even take out a personal loan.  Before you have this discussion, order a detailed credit report for each of you and then sit down and review them.  

What are the negative marks? If the ratio of outstanding debt to available credit is high, consider paying down the account with the highest interest rate. If there are a series of late payments, set up an automatic bill pay with your bank so that payment for these bills goes out on time. If one of you has great credit and the other mediocre, consider putting the person with mediocre credit on a credit card the other already has. It will allow the added person to build positive credit without taking on another form of debt. 

However, you will want to set boundaries and ensure that spending styles align - which brings us to the next topic. 

## Discussion #3 - Spending Style

*How much of your income do you want to save each month? On which items do you want to spend more money and on which items can you be more frugal? What are your long term financial goals?*

Some people are frugal with everything, some spend money like it’s water running out of the tap. But most people fall somewhere in the middle. Usually what happens is, one person likes to spend money on things like going out to dinner and shows, while the other wants to drive a nicer car or live in a more expensive home or apartment. There can also be a disagreement on how much is the right amount to save each month.  So talk about it.  Compromise.  And while you’re at it, set some long-term financial goals like buying a house, taking a year sabbatical or saving for your child’s education.

Once you’ve agreed on how to spend your money, put together a game plan, aka, a budget.

## Discussion #4 - Budgeting

*How much income are you bringing in each month? What are your fixed costs (i.e. costs that don’t change from month to month like rent or mortgage, utilities, cell phone bills, car payment, student loans)? What are your variable costs (i.e. things like food, clothing, and healthcare)?  How much are you saving? Is that enough to meet your long term financial goals within your ideal timeframe?*

Unless you have unlimited amounts of money, you will NEED a monthly budget. Creating a budget with two people who might have different financial priorities can be difficult, but start by listing your income and then all of your expenses (starting with your fixed). If the way you’re currently spending your money doesn’t align with your priorities and goals, compromise and make adjustments where needed.

Be sure to account for special savings accounts, such as an HSA or a 401(k). Knowing how much you are currently contributing to your savings can help you plan in the future - especially with your partner helping you. 

## Discussion #5 - Buy or Rent?

*Is it important for you or your spouse to own your home or are you fine renting?*

Purchasing a home is big endeavor and usually requires planning and saving (see discussions #3 and #4).  So talk about it.  If you decide it’s important to you both, then talk about the changes you’ll need to make in order to make that happen.

## Discussion #6 - Child Support	

*Do either of you have children from a previous relationship?  How will those financial obligations be handled?*

Even in common law states, where everything becomes joint property once a couple gets married, only the spouse who owes child support is financially liable for those payments.  But that usually isn’t the extent of the financial obligations that come with raising a child.  If you decide only the parent of said child(ren) will be financially responsible, you’ll also need to decide how that money gets separated out.

## Discussion #7 - Personal Financial History

*Has one or both of you declared bankruptcy?  If so, what were the circumstances?  Have there been any other financial troubles?*

This is perhaps the most difficult discussion because it could touch on other issues like addictions (gambling, shopping, drugs or alcohol) or a pattern of poor decision-making.  If you feel as though this conversation could get heated or emotionally fraught, seek the help of a therapist or counselor.  He or she could help guide the conversation in a non-threatening way.

## Discussion #8 - Who Will Manage the Money?

Sometimes this discussion is the easiest as one person generally shows more of a knack or interest for money management than the other. If that’s not the case in your relationship, be honest about each other’s strengths and weaknesses and try to make the best decision for your partnership.

Getting married is a fun and exciting time and it’s easy to get caught up in the celebration of it all. But before you get carried away, come back down to earth and have these important financial discussions. Setting a strong financial relationship between you and your partner will make it easier to have difficult conversations in the future. 
