Many employers pay a big share of your own coverage and much less for your spouse. Look at the difference between your "employee only" and "employee + spouse" paycheck deductions. That gap is what your spouse's coverage really costs you. If you're both young and healthy, a separate plan for your spouse can sometimes cost less, and your spouse may even qualify for Marketplace help on their own.
Find the real price of your spouse's coverage
KFF's 2025 survey of employer plans found workers paid, on average, $1,440 a year for single coverage and $6,850 a year for family coverage. At small firms (10 to 199 workers), family coverage averaged $8,889 a year out of workers' pay. Your employer usually pays a smaller percentage as you add people, and your share grows.
Here's the quick way to find your own number:
- Find your benefits sheet or enrollment portal and note the per-paycheck cost for employee only and employee + spouse on the same plan.
- Subtract. That's what your spouse's coverage costs per paycheck.
- Multiply by your number of paychecks. If the gap is $180 every two weeks, that's $4,680 a year to cover your spouse.
Now you have a real number to compare against.
Send me what you pay now for you plus your spouse. I'll show you what separate coverage would cost. Free, and no pitch at the end.
Why young couples get the worst end of it
Group plans charge everyone on a tier the same. A healthy 27-year-old spouse costs the same to add as a 58-year-old's spouse. On the individual market, price follows age: premiums can be up to 3 times higher for older people than for younger ones. Private medically underwritten plans also look at health. So the younger and healthier your spouse is, the more likely a separate plan comes out ahead.
Four ways to cover your spouse
Keep them on your work plan
Simple, one card, one deductible. Best if your employer pays a good share for spouses, or if your spouse has a health condition or you're planning a baby soon, since work plans cover pre-existing conditions and maternity.
Their own job's plan
If your spouse works, check what their employer charges for employee-only coverage. It's often much cheaper than adding them to yours. Some employers even add a surcharge for covering a spouse who could get their own work plan.
A Marketplace plan
Since 2023, whether family coverage through a job counts as "affordable" is based on what you'd pay to cover the family, not just yourself. If covering your spouse through your job costs too much compared with your household income, your spouse may qualify for Marketplace savings even if you don't.
A private plan
For a young, healthy spouse, a private plan priced on age and health can cost less than the spouse tier at work. These plans can decline applicants, may exclude pre-existing conditions, and often limit maternity coverage, so they fit best when neither is an issue.
The fine print, said plainly
- Pre-tax vs after-tax. Spouse coverage through work usually comes out of your pay before taxes. A separate plan is usually paid with after-tax money. I build that into the comparison (check the tax side with your tax preparer; this isn't tax advice).
- Timing. You can usually only drop your spouse from your work plan at your employer's open enrollment or after a life event. A separate plan should start the day the old coverage ends.
- Two deductibles. Separate plans mean separate deductibles and out-of-pocket maxes. If you both use a lot of care, that matters.
- Baby plans. If a baby might be on the way, keep maternity coverage in mind before moving anyone to a private plan.
What I check with couples
- Get your spouse-coverage cost from step 1 above.
- Check your spouse's own work plan, if they have one.
- Check Marketplace savings for your spouse based on your household income.
- Quote a private plan for your spouse's age, state, and health.
- Compare after taxes, and line up the switch with your employer's open enrollment.
Where I land
If your employer pays well for spouses, or your spouse has a health condition or a baby is coming, keep it simple and stay on the work plan. If you're both young and healthy and that spouse line is costing you thousands a year, it's worth one comparison. Check your spouse's own job first, then the Marketplace, then a private plan.
Send me what you pay now for you plus your spouse. I'll show you what separate coverage would cost. Free, and no pitch at the end.
Questions I get
Why does adding my spouse cost so much more?+
Many employers put most of their money toward the employee's own coverage and contribute less toward spouses and children. KFF's 2025 survey found workers paid an average of $1,440 a year for single coverage and $6,850 for family coverage, so the extra people cost far more out of your check.
Can my spouse get their own Marketplace plan with a subsidy?+
Possibly. Since 2023, whether family coverage through a job is affordable is based on what you'd pay to cover the family, not just yourself. If covering your spouse through your job costs too much compared with your household income, your spouse may qualify for Marketplace savings even if you don't.
When can I take my spouse off my work plan?+
Usually at your employer's open enrollment, or after a qualifying life event. Paycheck deductions are normally locked for the plan year, so check with HR before you plan the switch.
What if my spouse has a health condition?+
Then keep them on a plan that covers pre-existing conditions, like your work plan or a Marketplace plan. Private medically underwritten plans can decline applicants or exclude conditions.
What's a spousal surcharge?+
Some employers charge extra to cover a spouse who could get insurance through their own job. If you see one on your benefits sheet, it's another reason to compare.