Can I change my ACA insurance if I get married?
If I get married, am I allowed to change or update my ACA health insurance coverage?
Yes, getting married is considered a qualifying life event, which allows you to change or update your ACA health insurance coverage. Marriage triggers a Special Enrollment Period (SEP), giving you the opportunity to enroll in a new ACA plan or update your existing coverage outside of the annual Open Enrollment Period. Here’s what you need to know about updating your ACA health insurance after getting married.
1. Qualifying for a Special Enrollment Period (SEP)
Marriage is one of several life changes that qualify you for a Special Enrollment Period (SEP) in the ACA Marketplace. This means that you have a limited window of time to change or update your health coverage.
A. Timing for Special Enrollment
After you get married, you have 60 days to enroll in a new ACA plan or update your existing plan.
If you miss this 60-day window, you may have to wait until the next Open Enrollment Period to make changes unless another qualifying life event occurs.
2. Options for Changing or Updating Your Coverage
When you get married, you have several options for adjusting your health insurance coverage through the ACA Marketplace:
A. Enroll Together in a New Plan
You and your spouse can choose to enroll in a new plan together through the ACA Marketplace. This allows you to select a plan that meets both of your healthcare needs.
Depending on your household income, you may qualify for premium tax credits and cost-sharing reductions to lower the cost of your new coverage.
B. Add Your Spouse to Your Existing Plan
If you already have ACA coverage, you can choose to add your spouse to your current plan during the Special Enrollment Period. This allows you to stay on the same plan but with both of you covered.
C. Switch to Your Spouse’s Plan
If your spouse has ACA coverage, you may decide to switch to their plan and cancel your current plan. Your spouse can update their existing coverage to include you as a dependent.
If your spouse has employer-sponsored insurance, you can also switch to their employer plan, which may be more cost-effective in some cases. Losing your ACA coverage because you gain access to employer-sponsored insurance qualifies you for a Special Enrollment Period to switch plans.
3. How to Update Your Coverage After Marriage
To update or change your ACA coverage after getting married, follow these steps:
A. Log In to Your ACA Marketplace Account
Visit healthcare.gov or your state’s ACA Marketplace website.
Sign in to your account and go to the Report a Life Change section.
B. Report Your Marriage
Select the option to report your recent marriage. You will be asked to provide the date of your marriage and update your household information, including your spouse’s details and income.
C. Update Your Plan
After reporting your marriage, you can choose to add your spouse to your existing plan, enroll in a new plan together, or switch to your spouse’s plan. The Marketplace will show you the available options based on your new household status.
D. Check for Subsidy Eligibility
If your combined household income has changed after marriage, the system will automatically check whether you qualify for premium tax credits and cost-sharing reductions to lower the cost of your new or updated coverage.
Subsidy eligibility depends on your household income in relation to the Federal Poverty Level (FPL).
4. Subsidy Eligibility After Marriage
Getting married can affect your eligibility for subsidies to help pay for ACA coverage. Your combined household income is now used to determine whether you qualify for financial assistance.
A. Premium Tax Credits
Premium tax credits are available to households with incomes between 100% and 400% of the Federal Poverty Level (FPL). These credits lower the monthly premiums you pay for ACA coverage.
If your combined income falls within this range, you may still be eligible for tax credits, or your subsidy amount may change based on your new household size and income.
B. Cost-Sharing Reductions (CSRs)
If your household income is between 100% and 250% of the FPL, you may qualify for cost-sharing reductions (CSRs). These reduce your out-of-pocket costs, such as deductibles and copayments, when you use healthcare services. CSRs are only available with Silver-tier plans.
5. How to Compare Plans After Marriage
Before choosing or updating your ACA plan, it’s a good idea to compare the available plans to find one that meets your combined healthcare needs as a married couple. Consider the following factors when comparing plans:
Premiums: Compare the monthly premiums of different plans, keeping in mind any premium tax credits you may qualify for.
Deductibles and Out-of-Pocket Costs: Review the deductibles, copayments, and coinsurance for each plan to estimate your out-of-pocket expenses.
Network of Providers: Ensure that your preferred doctors, hospitals, and specialists are included in the network for the plan you choose.
Prescription Drug Coverage: If either you or your spouse take prescription medications, check the plan’s drug formulary to ensure your medications are covered at an affordable cost.
Key Takeaways:
Getting married qualifies you for a Special Enrollment Period, allowing you to update or change your ACA coverage within 60 days of your marriage.
You can enroll in a new plan together with your spouse, add your spouse to your existing plan, or switch to your spouse’s plan.
Your eligibility for premium tax credits and other financial assistance may change based on your new combined household income.
For personalized assistance with updating your ACA plan after getting married or understanding your subsidy eligibility, schedule an appointment with a Tsunami Advisor here: Schedule an Appointment.
