How to switch to your spouse's health insurance policy

Due to rising medical costs, individuals and families are trying harder than ever to find affordable health insurance. If you and your legal spouse are both eligible for employee health benefits, you should explore each company's health insurance options to see which is best for you and your wallet.

If you want to switch to a spouse’s policy, or your spouse wants to enroll in yours, it’s usually a simple task. However, it’s important to get the timing right and to know when you’re eligible for special enrollment periods (SEPs).

By taking the time to figure out which plan is best, you can save money on out-of-pocket costs and difficulties with your insurance provider. In this article, we’ll go over how to switch to a spouse’s policy during and outside the annual enrollment period and what circumstances can trigger a SEP.

Is your employer offering you a health reimbursement arrangement (HRA)? Learn more about them in our guide

Switching to a spouse’s policy during open enrollment

Changing your coverage is easy if you want to switch to a spouse’s health insurance policy during open enrollment. You simply need to cancel your current health plan and enroll in your spouse’s policy.

If you’re making the change to cut back on the cost of employer-sponsored health coverage and pricey medical bills, timing the change during open enrollment means you can start saving right away. Most organizations align their plan year with the calendar year. Open enrollment generally begins on November 1 for coverage starting January 1.

Ensure that your policy and your spouse’s policy follow the same plan year with the same effective date for changes made during open enrollment to avoid a gap in coverage. You should also confirm that your spouse’s policy will meet your needs regarding covered services and available providers.

For example, if you or any dependent children visit a specific primary care physician, you’ll want to ensure your spouse’s policy has them in their network.

If you’re switching from group health insurance to an individual or family plan because either your employer or your spouse's employer offers a qualified small employer health reimbursement arrangement (QSEHRA) or an individual coverage HRA (ICHRA), your spouse must be enrolled in an individual plan or family policy before they can participate in the HRA on a tax-free basis.

Changing health coverage outside an open enrollment period

Changing your current health plan to a spouse’s policy outside of the open enrollment period can be challenging. Your current policy’s coverage period may not match your spouse’s plan period, and coverage could be refused¹ until open enrollment rolls around again.

There are a few specific instances² where you can make changes. For example, if you have a cafeteria plan and had your hours reduced to fewer than 30 hours per week, or if you purchased a single-only health plan on the Health Insurance Marketplace or a state health insurance exchange, you can drop your current health insurance midyear.

Additionally, if your employer offers you a QSEHRA or an ICHRA, this triggers a special enrollment period (SEP), giving you a limited time of 60 days from when you are offered the HRA to change to your spouse's family plan from the marketplace.

Special enrollment periods

A SEP lets you review your health insurance options and enroll in health coverage outside the annual open enrollment period. Under specific circumstances, you may qualify to switch to your spouse’s health insurance during a SEP.

Certain life events trigger SEPs so you can review your coverage options and enroll in a new plan, including:

• Changes in household size, such as marriages, birth (or adoption) of a child, or divorce
• Change in your primary place of residence, such as moving to a new home in a new ZIP code or county
• Loss of health coverage, typically due to job loss
• When a spouse’s company stops making contributions toward their health coverage
• When a spouse loses Medicaid eligibility, no longer has access to Children’s Health Insurance Program (CHIP) coverage, or meets the eligibility requirements 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 SEP, you must show your company proof of your change in circumstances—such as a marriage certificate, annulment document, or child’s birth certificate—before the company will consider you qualified.

It’s essential to complete this verification process as quickly as possible. If you don’t submit proof within 30 days, your health plan selection may be canceled. You can reapply for the SEP and restart the verification process only if your qualifying event was less than 60 days ago, so don’t delay if you need to switch coverage outside open enrollment.

Conclusion

If you’d like to drop your current health insurance coverage and switch to your spouse’s policy, or vice versa, your first step should be to review each policy carefully so you and your spouse can choose the type of coverage that works best for you. You can typically switch health insurance coverage during open enrollment, but you may be eligible for a SEP if you have a qualifying life event.

Reviewing all potential costs of switching policies is vital, as additional fees could cancel out any potential health savings. Picking the best health insurance plan can take some research, so it’s critical to take your time to make the right decision for you and your family.

This post was originally published on November 4, 2020. It was last updated on January 11, 2024.