Should I Cover my Children on my Health Plan or my Spouse’s? Here’s How to Decide.

When both parents have access to employer sponsored health insurance, one of the most common questions families ask is, “Who should cover the kids?”. There is no single right answer. The best choice depends on the cost of coverage, the quality of each plan's network, and how the family uses care throughout the year. This article is meant to help you and your spouse work through the best option for you and your family.

The first step is to compare the cost of adding your child or children to each plan. Some employers charge a flat premium once a child is added, meaning the cost is often the same whether one child or four are enrolled. Other employers charge per child up to the first three children. Check your benefits and your spouse’s, is one noticeable more affordable for dependent coverage?

Cost should not be the only factor, though. A lower premium does not always mean a better fit once the network is considered. Check whether the child or children’s doctors and any specialists they see are in network on both plans. Families with a child who has an ongoing medical need, such as asthma, allergies, or a developmental condition, should pay close attention to which plan gives easier access to the specialists already involved in that child's care. Switching a child away from a trusted provider to save a small amount each month may not be worth it for your family.

It also helps to look past the monthly premium and compare deductibles and out-of-pocket maximums for family or employee and child(ren) coverage. A plan with a low premium sometimes carries a higher deductible, which can cost a family more over a year of routine visits, an unexpected surgery, or Emergency Room visit. A household with children who play sports or who see the doctor frequently may come out ahead on a plan with a slightly higher premium but lower cost sharing once the full year is considered. It can be helpful to add up the cost of premiums plus the possible total out-of-pocket expense to see if one plan comes out ahead in a worst case scenario.

Some parents may want to keep both plans active for the kids rather than choosing one, and that is allowed, but it raises the question of which plan pays first. Many employers use what is known informally as the birthday rule when both parents try to cover the same child on separate plans. Under this approach, the plan belonging to the parent whose birthday falls earlier in the calendar year, month and day only, is considered the primary plan for the children. Not all plans follow this rule, so it is worth asking each employer's plan documents how they coordinate benefits before assuming both plans will work together smoothly.

Before open enrollment, it helps to work through a short checklist:

1. Ask both employers about the exact cost of adding children to the plan.

2. Confirm the children's current doctors and dentists are in network on each option.

3. Compare deductibles, coinsurance, and out of pocket maximums for family and/or employee and child(ren) coverage, not just the premium.

4. Ask how each plan coordinates benefits if children may be covered under both parents.

If your employer works with a broker, ask if it is possible to talk to that broker and ask for their input. Strategic Benefit Partners, for example, is always happy to help employees compare coverage and assess specific needs to help determine if one plan may be more beneficial than another.

Ultimately, the choice of where to cover your child or children is yours and you can’t predict the future but, you can plan for best and worst case scenarios that can help determine which option is best for you and your family.