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Health benefits for
married couples
John Fried
Once you've gone and got hitched, life is all about
mixing it up. You merge your bank accounts. You file a joint tax
return. Heck, you even share a sock drawer. Why not think about
hitching up your health benefits as well?
If one of you has a job that offers health benefits
and the other doesn't, the answer is obvious: The spouse with coverage
should add the other to his or her plan as a dependent. Considering
the fact that 44 million Americans go without health care coverage,
no one who has the option should turn it down. But, since many couples
these days come into marriage gainfully employed and sporting their
own insurance, deciding whose health benefits to go with becomes
a matter of comparing the plans from head to toe.
Employers save money when you elect to decline health
coverage, so see if they'll give you cash back if you show that
you are properly covered under someone else's plan.
Cost
From a dollars and cents perspective, it's almost
always cheaper for a couple in which both people work to keep their
individual health plans. Adding a spouse to a plan typically costs
the employer more money, which translates to bigger premiums for
the employee.
Employers save money when you elect to decline health
coverage, so see if they'll give you cash back if you show that
you are properly covered under someone else's plan.
Plan design
Not all plans have the same benefits or the same level
of coverage. Say your spouse has a health package with a great dental
plan while yours has 20/20 vision coverage. If you've got eyes like
a hawk and a mouthful of teeth like Austin Powers, switching to
your spouse's plan may actually cost you less in the long run, particularly
if you make frequent visits to the dentist.
It's worth comparing the cost of out-of-pocket expenses
like co-payments for office visits and prescription drugs. Many
plans limit the drugs you have access to or raise the co-payment
for certain types of prescriptions.
Mental health care is another place they get you.
Some plans cap the number of visits to psychiatrists and social
workers or offer only a predetermined amount of coverage. Look closely
at your plans and determine which one does the most for you both.
You can get individual rating on insurers online through
the consumer site insure.com, which provides data from both Standard
& Poor's and Duff & Phelps. You can also see the 50 strongest
insurance companies according to industry analysts Ward Financial
Group.
Doctors
The most important issue for many people looking at
insurers is whether their favorite doctor is in the plan. If both
you and your spouse are covered by the same biggie, this isn't usually
an issue -- the network of doctors is going to be the same no matter
where you work. But if you're jumping to a different health care
provider, there's a good chance that the doctors won't be the same.
Consider your primary care provider and any specialists you or your
spouse use. Is that proctologist with the great sense of humor in
your spouse's plan? The gentle gynecologist? Staying with those
who make you feel comfortable is important -- they have your life
in their hands.
Along the same lines, be sure to take a look at your
out-of-network options. Many managed care plans allow you to move
outside the network of doctors and still get coverage. Again, it
comes down to the cost and hassle factor: How much paperwork and
bureaucracy will you be dealing with? How many phone calls to a
glassy-eyed drone is it going to take to get permission to go to
an out-of-network doctor on your spouse's plan? If it's more than
what you're dealing with now, you may be better off staying put.
Ultimately, it boils down to weighing cost vs. flexibility.
Work out a nice balance, and you could get better coverage and save
a little dough. Then you can start banking your pennies to help
pay for a whole new kind of dependent: kids.
-- Posted: April 17, 2000
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