Open Enrollment for Families

For Affordable Care Act (ACA) plans, the Open Enrollment Period for families begins on November 1 and ends on December 15.¹ During that time, you are responsible for making sure that you and your dependents have health insurance. If you do not obtain health insurance, you may be subject to a fine depending on the state in which you reside.²

At HealthMarkets, we understand that health insurance can be confusing, and everyone’s situation is unique. So, we’ve compiled answers to some commonly asked questions about health insurance and open enrollment for families.

Can I Get Insurance for My Spouse?

Before you purchase a health insurance plan, find out if you can include your spouse on that plan if he or she does not have independent coverage. Some employers offer family plans, but if yours does not, your spouse will need to enroll in an individual health plan.

If you already have a plan, call your health insurance company and ask about adding your spouse and/or children. During the Open Enrollment Period, you don’t need to have a qualifying event like marriage, adoption, or childbirth to add a spouse or children to your health plan, as long as your plan supports it.³

What If My Spouse Is Insured, But I’m Not?

You can inquire about becoming a dependent on your spouse’s plan, but some plans don’t offer family benefits. If you need to purchase an ACA plan on your own, you still need to report your spouse’s income on your application.⁴ Eligibility for lower costs on health insurance is based on total household income.⁵ If you’re eligible for your spouse’s health insurance but choose to buy your own insurance instead, you will only be eligible for lower costs if your spouse’s insurance is unaffordable – that is, the annual premium is greater than 9.83% of your annual household income.⁶

Are My Adult Children Covered?

If your plan covers children, they can stay on the policy until they turn 26. It doesn’t matter if they are married, live apart from you, attend school, or are eligible for an employee plan. If they are under the age of 26 and your policy covers your children, they are eligible.⁷ During the Open Enrollment Period, families can enroll their children in their main health plan.

What If I Get Pregnant?

Maternity care is an essential health benefit, and all qualified health plans must cover it, even if you are pregnant before your coverage takes effect.⁸ Each year, your health insurance company is required to provide you with a Summary of Benefits and Coverage (SBC). In this document, it will explain how the plan covers the costs of pregnancy, both before and after birth.⁹ Upon the birth of your baby, you will qualify for a special enrollment period which typically lasts 60 days after the birth of the child.¹⁰

What If I’m Divorced With Children?

The person who has custody of the child is responsible for that child’s health insurance. If you and your former spouse share custody, the person who is claiming the child as a dependent for tax purposes that year should include the child as a dependent when buying health insurance.¹¹

Is My Same-Sex Spouse Covered?

If you and your spouse are legally married in a state or jurisdiction that authorizes same-sex marriage, you are entitled to the same coverage offered to opposite-sex spouses, regardless of your state of residence, the location of the insurance company, or where the plan is sold or issued. As long as you file a joint federal tax return for the year you’re getting coverage, you may be eligible for premium tax credits. In short, legally married same-sex couples are entitled to all of the rights and privileges afforded to legally married opposite-sex couples.¹²

Whether you’re happy with your current health insurance plan or would like to learn more about all the options that are available to you and possibly switch to a new one, HealthMarkets can help during Open Enrollment for families. HealthMarkets’ innovative FitScore^®  can help you review your options to find the health plans that fit the needs of you and your family, all at no cost to you. Start comparing plans with HealthMarkets today.