Healthy Living

The Year of the Wedding and Everything Newlyweds Need to Know About Health Insurance

24 June 2022

Providence Health Plan Offers Resources and Support for Members During Big Life Moments

After two years of canceling and rescheduling nuptials, 2022 is predicted to be the biggest year for weddings since 1984, with an estimated 2.5 million weddings taking place in the United States alone. When life’s big moments happen, people need to understand their health insurance options. For example, did you know that couples have 60 days after their wedding to decide if they’re going to stay on their health plan or join a spouse’s?

Read on to learn more about what couples should consider when deciding on which health plan option is best for them.

Navigating Qualifying Life Moments

A qualifying life moment is any major life event such as getting married, giving birth, or moving to a new location. In most cases, people have 60 days from that qualifying life event to decide if they want to make a change to their health plan. Should a person miss the 60-day window to apply for a change to coverage, they will need to wait until the next open enrollment period to do so.

When deciding on health insurance coverage, newlyweds should ask themselves these questions:

• Does your employer offer coverage for your spouse?

• Is one person healthy and the other has medical needs?

• Are one or both of you self-employed, freelance or are you a contract employee?

• Does one or both of you already have kids? Are you planning to have kids right away?

Answering these questions will give couples clarity on what decision is best for them and make the process much smoother.

When comparing plans, it’s also important to consider:

• The total premium, or cost you will have to pay each month

• The plan’s benefits (i.e., how much do you have to pay every time you go to the doctor)

• The total out-of-pocket costs

• In-Network Providers: is your doctor and preferred hospital on the plan?

If you are not familiar with some of these terms, check out our “health plan basics,” which breaks down common terms you will find in insurance plans.

Starting a Family

Another key factor for couples to consider before making their health plan decision is if they are planning to start a family immediately. If newlyweds are planning for children shortly after they get married, they should consider a health plan’s maternity benefits and the costs for hospital delivery and regular check-ins with a doctor, compared to what their spouse’s plan offers. Additionally, it’s important to confirm if your preferred OBGYN and delivery hospital are in-network and will be covered by insurance. After having a child, it’s recommended the entire family be on one plan since the costs will be lower than the children being on a plan with one spouse.

Moving

As a newly married couple, you may have plans to move, and it’s important to know the qualifications that allow you to apply for new health insurance or join your partner’s plan:

• Moving to a new ZIP code or county

• If you’re a student moving to or from the place you attend school

• If you’re a seasonal worker moving to or from the place where you live and work

• Moving to or from a shelter or other transitional housing

It’s important to be aware of these qualifications because providers in your new city or county may not be in-network with your current health plan. Seasonal workers and students may also not be aware they qualify for this benefit, so being able to pass along valuable information like this is crucial.

Tips From a Providence Health Plan Caregiver

Shannon Drotning, Senior Director of Medicare and Individual Sales at PHP, recently joined KOIN News’ “AM Extra” morning show, where she discussed how she navigated the insurance process with her husband, while offering advice for engaged or recently married couples. Soon after Shannon’s wedding in 2019, she moved to Portland for a new job at PHP. At that time, her husband was going through treatment for Non-Hodgkin’s Lymphoma and was about to begin his third round of chemotherapy. As a result, the two had an important decision to make regarding health insurance.

After asking themselves the above questions and comparing plans with a focus on cost and in-network providers, Shannon and her husband decided it would be best for him to join her on the PHP employee insurance plan. Once the coverage kicked in, it was a smooth process for Shannon’s husband to access the necessary providers and specialists within the network, which allowed for no breaks or complications in seeking treatment.

Shannon recommends seeking out a local insurance agent as a trusted advisor to help make sure you have all the necessary information on various health plan options. They can also provide ongoing guidance to help you make the decision that is best for you and your spouse.

Choosing a new health plan shouldn’t be stressful, which is why PHP offers a variety of options and has caregivers who are here to support members throughout the decision process. Getting married, having a child and all other big life moments is exciting and requires a lot of planning and PHP is here to provide support for members in any way possible.

Need help? PHP offers members access to a team of enrollment experts, who can be reached by calling (503) 574-6505 or by filling out a contact form.