Spouses tend to be covered on the same health insurance policy.
But that’s not always possible, nor is it always the option that makes the most sense.
But the family out-of-pocket limit only applies to family members who are all covered under a single policy.
joeyful / Creative RF / Getty Images
(These limits are updated annually by the IRS, and tend to increase each year.)
It’s important to understand that although HDHPs can provide family coverage, HSAs cannot be jointly owned.
However, this isn’t necessary to get to have the money available for each spouse.
To avoid a penalty, the coverage has to be considered affordable for the employee.
But there is no requirement that the coverage for dependents be considered affordable.
And there’s no requirement that employers offer coverage to employees' spouses.
In that case, the spouse can only get primary coverage from their own employer’s plan.
However, employers are not required to ensure that coverage for spouses (or dependents) is affordable.
This was known as the family glitch.
However, other families may still find that their total premium costs are higher than they expected.
You have the option of putting both spouses on one plan or selecting two different plans.
you might also choose to have one spouse get an on-exchange plan and the other an off-exchange plan.
And it’s also important to understand how premium subsidies work in that scenario.
This sort of situation might change over time.
Summary
There are numerous reasons spouses may have separate health insurance.
There’s no one-size-fits-all in terms of whether spouses should be on the same health insurance plan.
December 12, 2022.
November 15, 2023.
AARP.Is there a dollar limit on my out-of-pocket costs in Medicare?
Internal Revenue Service.Revenue Procedure 2023-23.
Internal Revenue Service.Publication 969: Health Savings Accounts and Other Tax-Favored Health Plans.
Kaiser Family Foundation.Health Insurance Coverage of the Total Population.
Internal Revenue Service.Questions and answers on employer shared responsibility provisions under the Affordable Care Act.
Kaiser Family Foundation.2023 Employer Health Benefits Survey.
Accessed February 11, 2024.
2016;35(7):1167-75. doi:10.1377/hlthaff.2015.1491
Internal Revenue Service.Affordability of Employer Coverage for Family Members of Employees.
healthinsurance.org.Will the family glitch fix help my family?April 7, 2022.
KFF.Employer Health Benefits 2022 Annual Survey.
Medicare.gov.How Does Medicare Work?Accessed February 11, 2024.
Medicare.gov.What’s Medicare Supplement Insurance (MediGap)?
Medicaid.gov.Medicaid, children’s health insurance program, and basic health program eligibility levels.
Kaiser Family Foundation.Medicaid Postpartum Coverage Extension Tracker.
