Here's something that catches a lot of couples off guard: getting married or moving in together doesn't just change your relationship status—it can completely reshape your health insurance options and costs. Maybe you've both had your own employer plans for years. Or perhaps one of you has been buying coverage through the marketplace. Whatever your current situation, 2026 brings some critical changes you need to know about, especially with major shifts happening to marketplace subsidies.
The decisions you make about health coverage as a couple aren't just about which plan has better benefits. They're about understanding how your combined income affects subsidy eligibility, whether splitting coverage between an employer plan and the marketplace makes sense, and what options exist if you're not married but living together. Let's break down what you need to know to make the smartest choice for your situation.
How Marriage Changes Your Marketplace Subsidies
If you're married and want to qualify for marketplace premium tax credits, there's one non-negotiable rule: you must file your taxes jointly. You can't file separately and each claim your own subsidies based on individual income. The IRS is crystal clear on this—married filing separately makes you ineligible for any marketplace financial assistance, period.
Why does this matter so much? Because the marketplace calculates your subsidy based on your household's Modified Adjusted Gross Income (MAGI)—both incomes combined. For 2025, enhanced subsidies meant you could earn above 400% of the federal poverty level and still get help if premiums exceeded 8.5% of your income. But here's the tough news: those enhanced subsidies expire December 31, 2025. Starting in 2026, the old subsidy cliff returns. For a two-person household, that means if you earn more than roughly $81,760 combined, you get zero subsidy assistance.
Real people are already feeling this squeeze. One couple discovered that their combined income as newlyweds pushed them just over the 400% threshold. Her monthly premium, which had been subsidized, would more than triple in 2026. That's the reality for many middle-income couples—earn just a bit too much together, and you're suddenly paying full price for marketplace coverage.
The average increase? Premiums are expected to jump 114% for people losing subsidies, adding about $1,016 per year to costs. If you're planning to get married or you're already married and relying on marketplace subsidies, run the numbers now. You might need to explore employer coverage or other options before open enrollment closes.
Comparing Dual Employer Coverage: Which Plan Wins?
When you both have employer health insurance available, the temptation is to just pick one plan and add your spouse. But wait—this decision deserves a spreadsheet. In 2025, the average cost of employer-sponsored family coverage hit $26,993 per year, and it's been climbing 6% annually for three straight years. That's a lot of money coming out of your household budget.
Here's what to compare: Look at the employee-only premium for each plan versus the family coverage rate. Sometimes, it's actually cheaper for each partner to stay on their own employer plan rather than consolidating. Yes, you'll have two separate deductibles and out-of-pocket maximums to track, but the premium savings might be worth it. On the flip side, if one employer offers significantly better coverage—lower deductibles, broader network, better prescription drug coverage—it might make sense to pay more in premiums to get those benefits.
Don't forget to factor in the details: Does one plan have lower copays for specialist visits you need regularly? Better mental health coverage? A Health Savings Account option? In 2026, more marketplace plans are HSA-eligible, which could matter if you're comparing employer coverage to the marketplace. Also consider what happens if one of you changes jobs—you'd need to re-evaluate everything all over again.
The Split Strategy: One Employer, One Marketplace
Here's where things get interesting. Starting in 2023, new rules made it possible for your spouse to get subsidized marketplace coverage even if you have employer insurance. It all comes down to something called the "family glitch" fix. For 2025, employer coverage is considered affordable if your share of the premium for the lowest-cost employee-only plan costs less than 9.02% of your household income. But here's the key: there's now a separate affordability test for family coverage.
Let's say your employer coverage is affordable for you individually, but adding your spouse would cost more than 9.02% of your household income. Your spouse might qualify for marketplace subsidies. This is a game-changer for couples where one employer offers cheap individual coverage but expensive family add-ons. You stay on your employer plan, your spouse gets a subsidized marketplace plan, and you both save money.
The downside? You're managing two different insurance plans with two networks, two sets of claims, and two deductibles. If you need couples therapy or you're planning to start a family, having separate plans can complicate coordination of benefits. Still, the premium savings can be substantial enough to make the hassle worthwhile. Run the actual numbers using the marketplace subsidy calculator with your projected 2026 income.
Domestic Partners: Different Rules, Different Challenges
If you're living together but not married, your health insurance options work differently. Domestic partner coverage exists, but it's not guaranteed. Only about one-third of employers that offer health benefits allow employees to add a domestic partner. Even when it's available, you'll need to prove your partnership—requirements vary by employer and state, but typically you both need to be at least 18, share a residence, and meet specific criteria that the employer sets.
Here's the kicker: domestic partner health benefits are taxed differently than spousal coverage. The value of the coverage your employer provides for your domestic partner gets added to your taxable income. For 2025-2026, that could mean an additional $11,477 per year counted as income for tax purposes in some scenarios. You're essentially paying income tax on the benefit, which makes domestic partner coverage significantly more expensive than it appears at first glance.
The alternative? Each partner gets their own coverage, either through their own employer or the marketplace. If your income is low enough to qualify for subsidies—and you're not married, so you file taxes separately with only your individual income counted—marketplace coverage might actually be more affordable than trying to share employer coverage. The marketplace treats you as separate households, which can work in your favor for subsidy purposes.
What to Do Right Now
With the subsidy cliff returning in 2026 and employer premiums continuing to climb, couples need to take action during the next open enrollment period. First, calculate your projected 2026 household income. Be realistic—include salary increases, side income, investment earnings, everything that counts toward MAGI. Then use the marketplace subsidy calculator to see if you'd qualify for help.
If you both have employer options, request the exact premium costs for employee-only coverage and family coverage from each employer's HR department. Factor in deductibles, out-of-pocket maximums, and typical annual healthcare expenses for your situation. Compare those numbers against marketplace plans, especially if one spouse might qualify for subsidies under the family affordability test.
For domestic partners, find out if your employer offers partner benefits and what the enrollment requirements are. Then compare the after-tax cost of domestic partner coverage against each person getting their own plan. Sometimes the math is straightforward; other times you'll need to account for how much extra income tax you'd pay on the imputed income.
The bottom line? There's no one-size-fits-all answer for couples. Your best option depends on your specific income, the employer plans available to you, your health needs, and your marital status. But with premiums rising and subsidies changing, doing nothing is probably the worst choice. Take the time now to run the numbers, compare your options, and make an informed decision that protects both your health and your budget in 2026.
