Should You Choose Your Employer's Health Plan or Your Spouse's? Here's How to Decide.

Many married couples have a choice to make every open enrollment season. Both spouses may have access to employer sponsored health insurance; do you enroll under your employer’s plan and your spouse under their employers, or should you enroll together as employee and spouse? Deciding which employer's plan to use is not always obvious, and the right answer often changes from year to year as jobs, health needs, and family size change. Here is a practical way to think through the decision.

The starting point is almost always premium. Plans are almost never identical, but many employers cover a substantial amount of the employees premium so begin by comparing the cost of the coverage if you were both to enroll under your own employers plan and then compare the cost of enrolling as employee and spouse on each plan.

However, premium is only part of the picture. Deductibles, coinsurance, and out of pocket maximums can vary widely between employers, even when the monthly cost looks similar. A plan with a lower premium but a much higher deductible can cost a family more over a year that includes surgery, a hospital stay, or ongoing treatment for a chronic condition. We can never predict the future but also consider your risk tolerance and what you think your needs might be.

Network access also deserves attention. Check whether both spouses' doctors, along with any specialists either one sees regularly, are in network on both plans. This matters even more when a spouse is managing an ongoing condition or is expecting a child, since switching plans in the middle of a pregnancy or a course of treatment can mean starting over with a new provider or paying out of network rates. If one spouse's employer plan is tied to a well known regional health system and the other is not, that can shape the decision as much as the premium does.

A couple that is planning for or expecting a child should look closely at maternity coverage, the hospital network for delivery, and whether the pediatrician they intend to use is in network, since these details can matter more than the monthly premium in the first year. A couple where one spouse has a chronic condition, such as diabetes or a heart condition, should weigh the specialist network and the prescription drug coverage heavily, since ongoing care and medication costs can outweigh a lower premium elsewhere. And a couple where one spouse works for a large employer and the other for a small employer should pay attention to network size, since large employer plans often carry broader regional or national networks, while small employer plans can be more affordable but offer more narrow networks.

Here is a short checklist of what to consider:

1. Compare the premium for the coverage tier the household needs from both employers, not just the individual rate.

2. Ask each employer whether a spousal surcharge applies, and how much it costs.

3. Compare deductibles, coinsurance, and out of pocket maximums, not just the premium.

4. Confirm both spouses' doctors and any regular specialists are in network on each plan.

5. Factor in any planned medical needs for the coming year, such as pregnancy, surgery, or ongoing treatment.

Comparing two employer plans side by side takes time, and the details are not always easy to find without asking the right questions. Strategic Benefit Partners is always happy to help employees compare plans, or answer questions about employer coverage for employees to assist in the decision making process.