ACA Health Insurance: Different Plans For Different Family Members

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California leads the nation with starting the open enrollment for ACA health insurance on October 15, versus November 1 in the rest of the country. As I mentioned in the previous post When ACA Insurance Does Not Include Your Doctor, we are switching from a PPO to an HMO next year to save $5,600/year.

As I went through the open enrollment process, I noticed one thing that I didn’t know before. Although you report your total household income to the health insurance exchange, you don’t have to sign up all members of your household for the same plan.  When different household members have different healthcare needs, you can choose to enroll them in separate plans. Say within  a married couple, one of you is healthy and the other has more health issues. You can put the healthy person in a less expensive Bronze plan with a higher deductible, and you can put the other person in a Gold plan with no deductible and a low out-of-pocket maximum.

It gets a little more complicated when you have more than two people in your household who need ACA health insurance. You can have everyone in a Bronze plan, everyone in a Gold plan, or some in a Bronze plan and some in a Gold plan. The good thing is ACA open enrollment runs for a long time. In California you can make changes through December 15 for coverage starting on January 1. That gives you a lot of time to do the math multiple ways and see which way works the best for you.

Here’s how to enroll different household members in different plans in California’s ACA health insurance exchange (called Covered CA). For other exchanges, you can ask customer service how to do it.

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You see a list of household members and you click on Choose Plan.

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Next you see the concept of Enrollment Groups. An enrollment group is a subset of household members who will enroll into the same insurance plan. If you are having Mom plus two kids going into a Bronze plan and Dad going to a Gold plan, you will have two enrollment groups: Mom plus two kids in one group and Dad alone in a second group.

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By default they will create just one group and put everyone in it. You click on the Edit Groups button to split up.

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They say it’s usually best to go with just one group but you should do the math before you get here. Click on Continue if you already determined that doing separate plans works the best for you.

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The last option, Custom, allows you to split up your household the way you’d like. I would think it’s quite common for different household members to have different healthcare needs. If you choose a Bronze plan for everyone, you will pay a higher deductible. If you choose a Gold plan for everyone, you will pay higher insurance premiums. You may very well be better off by splitting up so that the healthy members will pay a lower premium and only the member with more health issues will pay a higher premium but will have lower out-of-pocket expenses.

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