Get Married to Cover Medical Costs
Ben and Coral Zalusky had no intention of getting married. Costiloe, who was 22 at the time of their meeting, had been married before. Costiloe had Type 1 diabetes, but was not insured. His health began to decline in 2005. The insulin that Costiloe received from the clinic was no longer effective in managing his low sugar levels. He started experiencing brain fog, night sweats and paralysis episodes. He would sometimes experience incontinence. Costiloe, now 61, said that every day became “a nightmare existence”. Costiloe said that every day was “a nightmare existence.” He is now 61 years old. Costiloe was forced to pay a higher price for a product he didn’t like. By 2007, Zalusky and he had had enough and decided that Costiloe urgently needed health insurance. Costiloe remembered that it was a sweet little ceremony. “It was a sweet little ceremony,” Costiloe remembered.
Costiloe enjoyed the benefits of being insured for two weeks before Zalusky lost her job, leaving both of them without coverage. Four years after that, they divorced.
Costiloe and Zalusky made up just one of the more than 2 million couples that married in the United States that year. Some of them, though it is unclear how many, considered insurance coverage when deciding whether or not to get married. Although there have been improvements in access to insurance in the decades since Costiloe’s and Zalusky’s wedding, Donald Trump’s election has brought back uncertainty about the future affordability of healthcare. Some couples are not concerned about the consequences of a hasty marriage. They may change their wedding date, reduce their guest list or host a smaller event. But for others, a hasty marriage could have serious consequences. And while for some couples the stakes are low–changing the wedding date, scaling down the guest list, or hosting a smaller event–for others, a hasty marriage could come with significant consequences.
“People are compelled to make life-altering decisions … just to access the medications they need to survive,” said Merith Basey, the executive director of Patients for Affordable Drugs, a nonprofit patient advocacy organization.
Some 50 million Americans have been able to secure access to health insurance through the Affordable Care Act since it was passed in 2010. Since 2010, the Affordable Care Act has allowed 50 million Americans to get health insurance. According to the health care policy research nonprofit, Americans worry more about medical expenses than they do about gas, food or rent. The health care policy research nonprofit also found health care is the expense Americans worry about most–“more than gas, food, and rent.”
Concerns about affordability are even more pronounced among certain groups of Americans–particularly people of color, members of LGBTQ+ communities, and those of lower income–who are less likely to be insured, research found. Pay disparities may also contribute to insurance access issues.
Insurance coverage doesn’t just influence when and how people get married. Researchers found that insurance coverage may also be a factor for separations. A 2015 article in the Journal of Marriage and Family revealed that people who have to worry about their health insurance are less likely to divorce. Dr. Heeju Sohn of Emory University, assistant professor of Sociology, found that the phenomenon was more pronounced when separated by gender. Women who depended on their husbands for insurance coverage had a lower divorce rate than men reliant on women. In a paper published in 2019, Dr. Tianxu chen, a professor from the University of Connecticut found a link between divorce and age. She wrote that divorce rates begin to rise in the United States when people reach Medicare eligibility at age 65, and they no longer require a spouse for private health insurance. But for others, like Jupiter Dior of Springfield, Massachusetts, the decision to enter into a legally-binding contract led to significant harm.
‘Trapped’
When Jupiter Dior, 31, began experiencing a series of abrupt and frightening symptoms including pelvic bleeding, weight gain, pain, and more, they didn’t know what to do. Dior was a nonbinary Black, low-income woman who couldn’t pay for a doctor. They lost four teeth in eight months, gained 135 lbs, developed pelvic bleeding through many pairs of underwear, and eventually needed surgery. The experience, they said, was “horrifying.”
So when Dior’s insured boyfriend proposed, they said yes despite their misgivings about his character. They said that they cried during their wedding ceremony, but they still went ahead with it at the county courthouse in Columbiana. Dior claimed that their husband began to abuse them, starting with financial and emotional abuse. Later, they alleged other mistreatment. Dior still needed the insurance their husband provided. So they stayed in the relationship, all the while feeling “trapped.”
Dior later divorced their husband–a move they said was due, in part, to being able to access health care through Massachusetts, where Dior resides. Dior said, “I wouldn’t have been in this relationship as long if my health care wasn’t tied to him.”
Crystal justice, chief external affairs officer of the National Domestic Violence Hotline, said that the hotline is experiencing its highest demand ever for services. This is especially true for those with chronic illness, disabilities or other conditions that require higher maintenance care. “Your literal survival is dependent on you having adequate health care coverage,” she said, and “that is going to be one of the barriers to you seeking safety and leaving an abusive relationship.”
Justice added that, since the Supreme Court ruling that overturned Roe v. Wade in 2022, the hotline has experienced more than double the reports of reproductive coercion–survivors calling in to report a partner using control or intimidation strategies to wield influence over their victim’s reproductive health or autonomy.
That trend may get worse under President Donald Trump. Trump and state legislators who are politically aligned have indicated that restrictions on abortion, contraception and even no fault divorce may be coming. This could leave domestic violence victims with few options to escape their abusers. And pregnancy, planned or not, increases the risk of intimate partner violence.
Insurance ‘made the decision for us’
Even when a relationship is healthy, the need for insurance coverage may push couples like Kate Lindsay and Tyler Miller to wed in less-than-ideal circumstances.
Lindsay, 32, is a freelance writer who spent a year on Miller’s health insurance as his domestic partner. Miller changed jobs in summer 2024 and his new insurance policy only covered spouses. This stipulation varies from state to state and insurer to insurer. She tried to get her own insurance, but she couldn’t find a plan that worked for her under the Affordable Care Act. She claimed that the monthly premiums began at $400 and that none of the plans would allow her to continue using her current doctors and prescriptions. Lindsay was also waiting for a response from a job that she had applied for and which offered benefits. The days passed. Lindsay paused her therapy and postponed other medical appointments to save money. Lindsay had to stop her therapy and delay other medical appointments in order to save money. Miller was required to enroll in the company-sponsored insurance program by a certain date. Two weeks later the couple married at New York City Hall. Lindsay added, “I liked it.” They were among 92 couples that were married by “a strange guy in a meeting room” on the same day. The brides’ smiles and compliments made the experience feel like a Barbie movie. Miller stated, “I got married, ate dumplings and got drunk with all our friends.” But Lindsay admitted annoyance that their hands were forced by insurance.
“It made the decision for us,” Lindsay said of having to consider health care affordability in the timing of their marriage. She said that their lives were the same before and after they got married, except now she could go to the doctors.
“The joke I made when we first discussed it was that this is a shotgun marriage,” Lindsay said. But our health insurance held the gun.”
