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Married couples vs. health insurance benefits

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 the plan as a dependent. Considering that 45.8 million Americans went without health care coverage in 2004, according to the U.S. Census Bureau, no one who has the option should turn it down. But in many marriages today, both spouses work and sport their own insurance plans. In these cases, deciding whose health benefits to go with becomes a matter of comparing the plans from head to toe.

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 such as 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 can 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 Standard & Poor's.

The most important issue for many people looking at insurers is whether their favorite doctors are in their group plans. If both you and your spouse are covered by the same big network, 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 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.

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.

Bankrate.com's corrections policy
-- Updated: May 8, 2006
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