Milestones in Life and Health Care Coverage

Health care coverage is not a one-size-fits-all proposition, and the right choice can change with milestones in life. Fortunately, today there are a number of different plans available. If you’re getting married, having a baby or facing a serious medical diagnosis, you will want to take a moment to re-evaluate your coverage to make sure your plan offers you and your family the protection you need.

Getting Married

When you get married, the first health care question you’ll want to ask is: Is your spouse covered by his or her own personal or employer-provided health plan already?

  • If your spouse is covered by a personal plan bought through the Affordable Care Act (ACA) exchange and receive a subsidy toward his or her monthly premium, your spouse will no longer be eligible for that subsidy upon marriage if they can be added to your own health plan, according to the IRS.
  • If your spouse is covered by an employer-provided plan, compare your coverage options with your spouse’s. As notes, marriage counts as a special enrollment event, so you’ll have a brief window to make changes to your health care plan after your wedding.
  • When comparing your insurance plans, be sure to compare what percentage of your premiums your employers cover. Calculate whether staying on your own individual plans is your best option or whether it makes the best sense financially for both of you to have the same plan.

Growing Your Family

For many people, having a baby is one of the most significant milestones in life. As you no doubt already know, growing your family can be expensive in various predictable and unpredictable ways. Planning ahead for your new little one’s health care coverage can eliminate one source of surprise expenses.

After your child is born, you’ll have a special enrollment period during which you can sign your child up for coverage. You’ll have a set amount of time to enroll your child in a health plan, and enrolling your baby within that time frame typically provides coverage retroactive to their date of birth. Again, compare your own coverage opportunities against your spouse’s, and ask yourself: Is this the right time to make a change in coverage for the whole family? According to, pregnancy and birth are covered under nearly all health plans; but, as the United States Department of Labor notes, the care your baby receives after birth must be covered by the child’s own coverage. Making an informed decision promptly can help make sure any costly medical expenses are covered.


Your health will change over time, with challenges large and small. Thanks to the ACA, the U.S. Department of Health & Human Services points out that people with pre-existing conditions can no longer be excluded from coverage or face a period of noncoverage when changing health plans. Unlike marriage and birth, however, a change in your health won’t qualify you for a special enrollment period. This means that you must carefully look ahead and, with the knowledge of your health that you now have, make an informed decision about your coverage needs.

Does your diagnosed condition require appointments with specialists and regular lab tests? If so, you may be better covered by a preferred provider organization plan rather than a high-deductible health care plan (HDHP). With a PPO, while your monthly premiums will be higher, your ongoing copays will be a set amount that you can budget for. Are you facing hospitalization or surgery? If so, consider the deductible and out-of-pocket max amounts an HDHP offers. You may find, when comparing your PPO and HDHP plans, that the latter is more budget-friendly in the long term if you’re facing a potential mountain of health care costs.

You’ll pass many milestones in life that impact health care coverage for you and your family. When you carefully consider your options, costs and needs, you’ll be well-positioned to make the very best decision.

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