Saying ‘I do’ -- for a health plan

Tamra Crume had little intention of marrying again. She tried it once before, in her early 20s, and thought the whole idea was outdated, oppressive, unnecessary.

But there they were last New Year’s Eve, she in her short sleeve, off-the-rack sea-green dress, her partner of a dozen years, Keith, in a gray suit from the closet, driving 45 minutes to a suburban Maryland courthouse to say “I do.” Why the sudden change of heart?

“I needed health insurance,” says the 38-year-old catering manager, who was so nonchalant about her nuptials she bought a cheap disposable camera for pictures on the way. She took one photo: It came out fuzzy and cropped her at the knees.

Crume had moved from Oregon to Washington, D.C., two years ago and couldn’t find work. Her doctor and prescription bills were running several hundred dollars a month. Her boyfriend’s generous government insurance benefits looked more and more attractive.

“I figured it made more sense to pay the money to get married rather than keep paying the bills,” she says.

Love and marriage may go together like a horse and carriage, but for some couples a dance down the aisle these days may have more to do with dollars and cents. Although no one keeps statistics on how many couples marry each year to gain access to health benefits, there are signs the arrangements are growing among people who can’t afford medical coverage and those struggling under the burden of rising insurance premiums.

Advertisements on the New York City subway this month by a group promoting affordable health insurance read, “Get Married for Love, Not Health Insurance.” Internet chat rooms are filled with people communing about the benefits of marrying for health benefits and trading tips on how to do it right. (Fees for marriage licenses and other costs can vary considerably depending on where people get married.) Some patient advocacy groups, including the American Diabetes Assn. and the American Cancer Society, say a small but growing number of seriously ill people are using marriage as a last resort to deal with potentially crippling medical bills.

The recent legalization of gay marriage in Massachusetts also could lead more couples to marry for medical benefits. Last month, town managers in Springfield, Mass., stopped offering domestic partner benefits to unmarried couples and gave them 90 days to marry if they want to keep their insurance benefits. Other Massachusetts employers, including Boston College and Beth Israel Deaconess Medical Center in Boston, are ending partner benefits by the end of the year.

Unlike the 1990 movie “Green Card,” in which two strangers marry so one can stay in the country and then later fall in love, most couples who marry for insurance reasons have been together for years. Many explicitly didn’t want to get married -- or at least had not planned to wed so soon. Occasionally, friends marry friends or a single parent with a sick child and mounting medical bills finds someone to marry and agrees to pay the extra insurance costs.

Experts say those marrying for health insurance should be careful. Although the long-maligned “marriage tax” has been reduced in recent years, financial experts say some couples may still pay significantly more in income tax once they’re married. What, too, if love ever wilts? Divorce lawyers recommend couples marrying explicitly for insurance reasons have a prenuptial agreement in case the relationship sours down the road.

Drew Tipson and his wife, Emma Brooks, had been in a relationship for years but didn’t consider marriage until last year, when Tipson began having intense pain in his neck and head, which doctors still haven’t explained. Tipson, 26, is a freelance worker for a Manhattan law firm and doesn’t qualify for health insurance. Brooks, a 25-year-old medical student, has health insurance, but her plan doesn’t cover unmarried domestic partners unless they are gay.

So, just weeks after telling their parents they probably would never legally marry, the two families found themselves together at a New York City courthouse during Tipson’s lunch break. The 10-minute civil ceremony wasn’t the wedding his parents might have imagined.

“The most tragically bored woman in history read out the ceremony script in a nondescript room that could have been a police interrogation chamber,” he says. Afterward, “the two of us left and headed down different subways to go back to work. I think my parents were left standing there thinking, ‘What in the heck just happened?’ ”

People with disabilities or facing life-threatening illnesses face higher stakes. John Bennett, 34, of Cincinnati married his longtime partner two years ago. She has multiple sclerosis and lost her insurance after finishing graduate school in 2001. Without dual coverage, Bennett says, the couple could face financial ruin if his wife has another flare-up of her MS, which last happened three years ago. She already filed for bankruptcy protection after she was first diagnosed a decade ago and didn’t have insurance.

The pair has saved thousands of dollars in insurance costs so far. It now costs $200 a month to insure them both, instead of the roughly $500 a month that Bennett’s wife would pay just to cover herself, because of her preexisting condition. “We needed a safety net,” he says.

According to the Henry J. Kaiser Family Foundation, a health policy group based in Menlo Park, Calif., health insurance premiums rose 13.9% last year, the third consecutive year of double-digit increases. The average cost of coverage for a family of four is $9,100 per year, and the average individual insurance plan runs $3,400 a year. Considering that an estimated 44% of Americans lack health insurance, it’s easy to see why some people might turn to marriage to get access to insurance.

Kathleen Stoll, director of health policy at Families USA, a Washington, D.C.-based health consumer group, says the rising cost of health insurance is increasingly affecting people’s lifestyle and career decisions: having more children, where to live, changing jobs or going back to school. She says it’s not uncommon for couples to divorce so one can qualify for coverage through Medicaid.

“Getting married for insurance may sound silly,” she says, “but it’s no joking matter. It’s a serious example of just how difficult getting affordable health insurance is for most people.”

Although companies are not required to offer employees health insurance, if they do they must cover an employee’s spouse no matter his or her medical history. But a growing list of employers, from Boeing Co. to the University of California system, have recently started asking employees to pay significantly more if they want to cover family members.

In most states, common law marriages are of little use because insurers typically won’t include a common law spouse on an employee’s health plan.

Dave Hennings, a spokesman for the National Health Care Anti-Fraud Assn. in Washington, D.C., says it’s unlikely insurers would deny coverage to anyone who marries for insurance benefits. “I think most people would agree this doesn’t rise to the level of fraud,” he says.

There are proven advantages to tying the knot. For example, studies show married couples live longer than those who only live together. Married couples also benefit from visitation rights at hospitals and the ability to will a partner an estate without paying capital gains tax.

Still, couples who married solely or largely for medical benefits don’t always tell their families or friends that they are married -- or why they married. Many don’t wear rings, take each other’s names or go on honeymoons. Some keep their marriage under wraps because they worry that others might minimize their relationship if they knew the reason for the wedding, or that family members might get angry.

“This is our dark secret,” says Bennett, who says he and his wife have mentioned their marriage only twice, to their doctor and to his company’s human resources manager. Recently, he had to look at their marriage license to remember their wedding date.

Marijah Sroczynski and Paul Adams of Orange, N.J., married five years ago so he could work as a freelance sound engineer in New York theaters, a job that doesn’t provide insurance. She rarely mentions she’s married.

Adams, however, sometimes jokes about his marriage to his uninsured friends in the theater world. “He loves to pull out his insurance card when they are complaining about not having insurance,” Sroczynski says. “He tells them it’s the best reason to get married.”