Your Spouse's Work Plan Costs Too Much to Add the Family

Look at the pieces, not just the total

Most employer plans price by tier: the employee alone, the employee plus a spouse, the employee plus children, and the whole family. Ask HR for each tier. The cost of adding people is often the biggest jump, and the difference between tiers can tell you where the money goes.

Also ask for the deductible and out-of-pocket maximum for the family tier. A plan with a payment that looks manageable can still ask a lot when someone gets sick.

Mix and match

Many employers let an employee cover some family members and not others. Your spouse might stay on the work plan alone while you and the children look at something else. Or the children stay on the work plan and you do not. The pieces that make sense depend on who needs what.

For children, Florida KidCare is a state program for those who qualify. It depends on household income and other rules, so check before you assume.

The timing trap

An employer plan usually lets you add family only at its yearly enrollment or after a life event, such as a marriage, a birth or the loss of other coverage. Those windows are often short, around thirty days. If you decide later that you want the family on, you may have to wait. A private plan can be applied for at any time of year, so it does not have the same clock.

What about the Marketplace?

When an employer offers coverage, a federal rule change means family members can now be judged by the cost of the family coverage the employer offers, not only the employee's own coverage, when deciding who may get help with monthly costs on the Marketplace. Your household income and other rules still matter. HealthCare.gov can tell you what your household qualifies for, so check it before you decide. We do not sell Marketplace plans.

A private plan for part of the family

A private plan can cover some people while the work plan covers others. The plans we offer are private plans, not ACA Marketplace plans, and they have exclusions and limitations. An advisor explains the details.

Our plans are for people under 65. Your advisor can walk through who in the family could stay on the work plan and who could look at a private plan.

Compare the whole year, not the paycheck line

Put the options side by side. For each one, write down the monthly payment, the deductible, the copays, the out-of-pocket maximum, the doctors in the network and the prescriptions covered. A low payment with a high deductible may cost more in a year with doctor visits than a higher payment with lower costs at the counter.