How can I insure my spouse on the private market?

May 13, 2011 9:45 AM

I'm going nuts trying to figure out the rules on how to get my spouse on an individual high-deductible health plan when coverage is theoretically available through my employer. The internet is useless. Can the hive mind help me here?

Here's the situation: New employer, Rhode Island. Married with no kids, spouse does not have an employer that provides health coverage. My new company heavily subsidizes individual health insurance but only pays 50% of the premium for a family plan (and "individual+1" is not offered). We could save about $400 a month by enrolling me as an individual in my employer's plan and covering my wife on the private market.

Here's the problem: Blue Cross is the only insurer providing individual coverage in RI. The eligibility guidelines state: "You are eligible to apply for coverage under this agreement if . . . you are not eligible for employer-sponsored group coverage or similar coverage."

This is consistent with HIPAA and with rules of other states that I've seen while poking around the web.

I don't want to be stuck with an expensive family plan that I don't need. I'm willing to put my spouse on a catastrophic plan and pay full price up to whatever deductible makes sense. But that doesn't seem to be a legitimate option here. Has anyone been in this situation? What can I do?

posted by anonymous to Health & Fitness (7 answers total)

I'm in MA, and while I haven't been in exactly this situation, I've also had maddening issues with finding affordable health care. After being unemployed for 7 months, I found a part-time job which offered health insurance. My intent was to continue on Cobra coverage (which was being subsidized by the state because I was still getting unemployment benefits). Unfortunately, I then found out that I couldn't continue on Cobra if my new employer offered insurance, and I also was not eligible for any of the state offered plans for the same reason you list above "you are not eligible for employer-sponsored group coverage." The most frustrating part is that it doesn't matter the rate at which your employer subsidizes the health insurance. In my case, I pay 70% of the cost, which, as a part-timer, is a huge chunk of my check.

It's unfortunate, but I think you are stuck here.
posted by Sal and Richard at 10:05 AM on May 13, 2011

Seeing that individual +1 is not the option, perhaps you can call Blue Cross RI and ask if this is allowable. Perhaps their guidelines are if they didn't explicitly offer indiv + 1 then no, she doesn't qualify as group eligible through your employer.

https://www.bcbsri.com/BCBSRIWeb/plansandservices/individual_plans.jsp
call (401) 351-BLUE (2583)
posted by stormpooper at 10:13 AM on May 13, 2011 [1 favorite]

I think, though, that your wife would be considered eligible since a family plan is an option. Nothing is preventing your wife from being on family plan through your employer, except that you're finding the cost prohibitive (and understandably).

My employer used to have an individual+1 insurance option, but it was dropped a few years ago for individual or family only. So, married couples through my employer have to join the family plan if they wish to join our health insurance program. I think a lot of insurers have dropped the option as a plan in recent years.

I don't know enough about insurance to know if this is the case, but it may be that Blue Cross would consider your wife eligible for your employer's plan.....just be prepared for that possibility.

And is there any reason neither of you have called to figure this out? You may be able to receive clearer answers by speaking directly with a BCBS employee....though I know what a headache calling insurance companies can entail, too.
posted by zizzle at 11:15 AM on May 13, 2011

Anon, they have a triage program called AskBlue which may also help you figure out if she's eligible.
posted by stormpooper at 12:17 PM on May 13, 2011

Your employer's health plan person is the first and best source for this information.
posted by KRS at 1:15 PM on May 13, 2011

By the letter of the rule, your spouse is not eligible for employer sponsored insurance because the spouses employer doesn't offer it. It is my understanding that HIPPA interprets this as the individual applicants employer and not any other family members employer. I know plenty of people in MO (including people at my own place of employment who had BCBS last year) and AR who have individual coverage while their spouse has employer coverage of their own. These are states heavy in BCBS coverage as well.

Best thing to do is call BCBS and ask.
posted by MultiFaceted at 3:57 PM on May 13, 2011

Please forgive my lack of necessary apostrophes lacking above.
posted by MultiFaceted at 3:57 PM on May 13, 2011