Your Health Plan or Your Spouse's?

Medically Reviewed by Charlene Frizzera on April 26, 2013
3 min read

When you and your spouse or partner have access to company health insurance plans, you need to be a savvy shopper.

When annual enrollment rolls around, it helps to understand all your options so you can make the best choice.

You should pick the plan that offers the most benefits for the lowest costs, says John Hearn, principal with The Benefit Company, an employee benefits consulting firm in Atlanta. "The right plan for one family may be very different than the right plan for another family."

Try these tips:

Estimate your medical costs. Make a list of the medical services you'll likely use in the next year. For example, how many primary doctor visits, specialist visits, and drug prescriptions will you need. Then add up how much you would have to pay under each plan.

Check the premiums. A premium is the amount you pay each month for the coverage. Different plans have different premiums.

Compare deductibles. A deductible is a specific amount that you have to pay for health care services before your insurance plan begins to pay for them. See whether your plan or your partner's plan has a deductible that's right for your budget.

Check whether your current doctors are in the plan's network. Plans provide directories of "in-network" doctors.

You will still be able to go to an out-of-network doctor, but you will pay more for that doctor's services.

Check to see which plan, either your plan or your partner's, includes more of the services you need. For example, which plan includes:

  • Prescription drugs
  • Mental health care
  • Home/nursing care
  • Dental care
  • Vision care

Check to see if it costs less if each of you go on separate plans.

Also, some couples may have no choice but to enroll in separate health insurance plans as the Affordable Care Act rolls out. The new health care law has new requirements that affect the cost of insurance coverage. Your employer will be able to help you with those changes.

Your companies' health insurance plans aren't your only choices. You and your partner can buy private insurance. Under the Affordable Care Act, you can also buy coverage from one of the health plans in your state's health insurance Marketplace, also called an Exchange.

If you're deciding between two employer plans, consider putting your children on the plan that offers the most benefits for the lowest cost. "You just look for the lowest-cost option you can find for them that provides the coverage you're comfortable with," says Steve Wetzell, an independent health care industry consultant.

You and your spouse or partner might want to enroll in a flexible spending account (FSA). An FSA allows you to set aside money out of your paycheck before taxes so you don't have to pay tax on it. You can use this money to pay for medical expenses that are not covered by your health insurance plan.

"So it may make sense to have two accounts if you have a lot of expenses," says Paul Fronstin, PhD, director of the Health Research Program at the Employee Benefit Research Institute.

If you have questions, call the health plan or your company's human resources manager and ask for help. Also check to see what tools or resources are available. Some employers offer worksheets or online tools to help you estimate costs and compare plans.