Family Health Insurance Plans Explained


WRITTEN BY: Craig Sturgill

UPDATED: NOVEMBER 04, 2022 | 2 MIN READ

Family health insurance works the same way as individual health insurance. The only difference is it covers multiple people. Because of this, they often have a higher deductible, monthly costs, and out-of-pocket maximums.

What Is a Family Health Insurance Plan?

Affordable Care Act (ACA) requires all health insurance plans, including family ones, to cover specific health benefits:

  • Prescription drugs
  • Hospitalization
  • Emergency services
  • Pediatric services
  • Outpatient services
  • Laboratory services
  • Maternity and newborn care
  • Preventative care and wellness services
  • Rehabilitative services
  • Mental health and substance abuse care

Who Is Eligible For a Family Health Insurance Plan?

Families come in many shapes and sizes, but not everyone qualifies for family health insurance plans. There are many questions about who can be on a family policy. We have the answers you need whether you have a spouse or a domestic partnership.

Can you enroll your spouse?

Your spouse is eligible to be enrolled on your health insurance policy. However, domestic partners aren’t allowed to be part of your family plan unless you live together for a pre-determined amount of time and your state recognizes common law marriage.

Are family plans right for married couples without children?

You might opt for low-cost individual health insurance plans if you’re married without children. You’re eligible for a family insurance plan, but the argument is that you may pay the same premium for a two-person household as you would for a four-person household. Compare the cost of individual plans and family plans before enrolling to determine what is most cost-effective for you.

Can you add a domestic partner to your health insurance plan?

You can get insurance for a domestic partnership if your health insurer honors domestic partnerships. It’s best to contact your insurance company to determine whether the insurance company honors it. If domestic partnerships are allowed by law in your state, the insurance company has no choice but to honor them.

Do you need a family plan if you’re pregnant?

All health insurance plans include maternity care as an essential health benefit, even though it’s a pre-existing condition. Your individual plan covers the costs of pregnancy before and after birth. If you decide to enroll in a family plan once your baby is born, you qualify to enroll during a Special Enrollment Period.

Is your same-sex spouse covered on your health insurance plan?

An insurance company has to give same-sex couples coverage if they are married. Same-sex couples must have the same coverage as opposite-sex spouses. 

It’s true regardless of the state where:

  • The plan is sold, issued, renewed, or in effect
  • The couple lives
  • The insurance company is located

Are your adult children covered on a family health insurance plan?

Family health insurance plans cover children until age 26. They can stay on your health coverage even if they’re away at college.

Marketplace Family Plans

If your employer doesn’t offer insurance options, you can browse the plan on the ACA Marketplace. Before shopping, learn about the health insurance Marketplace metal tiers and ACA plan types.

Family plans by metal tier

Each ACA plan falls under a metal tier: bronze, silver, gold, platinum, and catastrophic coverage. Each metal tier offers unique benefits and drawbacks, so review each type to find the best option for your family.

Family plans by plan type

ACA family plans are split into four types: PPOs, POSs, HMOs, and EPOs. Depending on the plan, your family may be able to use almost any doctor or healthcare facility, while others may charge you more, require referrals, or limit your choices if you use out-of-network providers.

Family Health Insurance Plan Costs

There are many different things to consider when looking for family health insurance. There are a few different costs involved that you want to take into consideration before deciding on a plan.

Premiums

Premiums are your monthly payments for your family insurance plan. The average cost for premiums for family coverage is $1,168.

Out-of-pocket expenses

Your out-of-pocket expense is the total you pay yearly before your insurance covers you fully. Your out-of-pocket maximum depends on the type of coverage you purchase. Typically, the more expensive your premium, the lower your out-of-pocket maximum.

Co-pays

Your co-pay is the amount you pay when you visit the doctor. For example, if you have a $50 co-pay, you pay the doctor $50 each time you visit, and your insurance company pays the rest. Typically, health insurance coverage has separate co-pays for regular office visits, visits with specialists, and emergency care.

Cost-Reducing Options for Family Healthcare Plans

Family coverage can be expensive, and unexpected medical expenses can impact your finances if you don’t have the right coverage. If you’re having trouble affording health insurance, some programs and incentives may help.

ACA subsidies

The Affordable Care Act provides tax credits for those that qualify. Generally, the lower your income and the larger your family, the greater the tax credit you may receive.

CHIP plans

The Children’s Health Insurance Program (CHIP) is a federal-state collaborative effort providing free or inexpensive health insurance for families with children. State requirements vary, but you’ll usually qualify for CHIP if you make too much to be eligible for Medicaid but have an income 200% below the poverty line.

Other options

You may qualify for state or federal help if you’re a family of four with an income of less than $99,000 a year. Short-term health insurance is also available, although your family won’t receive the same coverage from major medical plans.

Family Health Insurance Plan Considerations

When shopping for health insurance coverage, there are things to consider before making a decision. You might think that a plan with a low premium is a great idea, but if you have children on your plan, you might end up with high out-of-pocket costs. If you have a higher premium, you will have low out-of-pocket costs later. If you have a large family, insurance is more expensive.

Family Health Insurance FAQs

What does a family plan mean in health insurance?

Individual plans cover one person, while a family plan covers more than one person, such as a spouse or children under the age of 26.

What’s the difference between a family plan and an individual plan?

Family health plans and individual plans only differ in the number of people covered. An individual plan is for one person, while a family plan is for two or more people.

Why does a family plan cost more than an individual plan?

A family plan costs more than an individual plan as more people need coverage.

What are the pros and cons of family health insurance?

The biggest pro of family health insurance is that you have coverage for your whole family. The biggest con is that it’s more expensive than individual insurance.

How does health insurance work for a family?

Family plans are for two or more people. Your plan’s deductible is based on your family’s number of people. On average, the deductible and out-of-pocket costs are double of an individual plan.

Are family plans cheaper than individual health insurance?

Individual plans are generally cheaper than family plans because they don’t list dependents. Your actual cost will depend on the plan you choose.

How much is a family plan on Obamacare?

Your actual cost depends on your plan type and metal tier. For the 2021 year, a family plan can’t cost more than $17,100.

What is the difference between Obamacare and Medicare?

Obamacare refers to private health plans available via Healthcare.gov, and Medicare comes from the federal government.

What is the deductible for a family plan?

Your deductible will depend on your specific plan. Many plans cover in-network preventive care, and others may even waive your deductible for other covered costs.

What is the difference between a family plan and an individual plan?

An individual plan has one member on the policy, and a family plan is like an individual plan with multiple members.

What is the average cost of a family plan?

In 2020, the average national premium for a family plan costs $1,152 per month. Your actual cost will depend on your plan.

Finding a Family Health Insurance Plan

Finding a family health insurance plan is simple. Get several health insurance quotes, compare them, and choose the best coverage for you and your family.