In recent months, companies have made waves with COVID vaccine mandates and other initiatives to encourage employees to get the shot, such as Delta Airlines charging an extra $200 per month for employees to remain on the company’s health insurance. Ochsner Health System in Louisiana announced employees will be subject to around a $200 per month surcharge if a covered spouse or partner is not vaccinated against COVID-19. The major health care system cites the almost $9 million spent on COVID-19 care for their covered employees and spouses over the past year as the reason for the surcharge.

“Surcharges, rate-ups, and premium increases based on high-risk behavior have always been principal determinant factors in the insurance industry,” says Dr. Noor Ali, Healthcare Advisor. “The entire premise of insurance is risk, and unvaccinated individuals are simply a higher risk for employers, insurance companies, and populations as a whole. The outcome is higher medical bills, more time off due to illness and disability, and slow progression to achieve herd immunity.”

Will this additional charge convince more people to get vaccinated? Or will employees instead decide to drop their employer-based health insurance? We surveyed a total of 1,000 employees with unvaccinated spouses covered on their plans, along with unvaccinated people receiving health insurance through their spouses, to find out what they would do if their companies decided to adopt a similar measure.

We found that:

  • The largest percentage in both groups (39% for employees and 37% for spouses) would choose to stay on the company plan and pay the extra $200/month
  • 35% of spouses would get the vaccine to avoid the surcharge and stay on the plan
  • Many believe smokers should be charged more for health insurance but unvaccinated people should not

Most Employees Would Not Ask Their Spouse to Get the Vaccine

Of the employees we surveyed, only 31% said that a $200 monthly surcharge would motivate them to ask their spouses to get vaccinated, leaving more than two-thirds who would opt for a different route. Of this 69% who would not ask their spouses to get vaccinated, 39% say they would stick with the plan and pay the extra $200/month, 20% say they would drop their company’s health insurance plan, and 10% would choose to stay on the plan without coverage for their spouse.

The results were similar among unvaccinated people who receive health insurance through their spouses. Just 35% said they would be willing to get the vaccine if faced with this situation, while 37% agreed that they would prefer to stay on their partner’s plan and pay the extra $200/month.

When asked if they think companies are within their rights to institute the spousal surcharge, respondents were split fairly evenly, with 54% saying they think companies are within their rights and 46% responding that they didn’t think so. When filtered by political affiliation, the results were different, with 65% of Democrats saying that companies are within their rights and only 47% of Republicans saying the same.

A Personal Decision? Many Believe Tobacco Users Should Be Charged More for Insurance but Unvaccinated People Should Not

Among respondents who answered that no, companies are not within their rights to institute the spousal surcharge, 54% think that it is fair for tobacco users to be charged more for health insurance. “Smoking and opting not to get vaccinated are both lifestyle choices” says Ali. “It will be up to the actuarial professionals to determine the formulas of risk.”

Both the decision to use tobacco and to get the COVID-19 vaccine can be viewed as personal decisions, yet a greater percentage think tobacco users should be charged more while unvaccinated people should be charged the same as vaccinated. When we asked the same group of respondents why they don’t think companies are within their rights to impose the surcharge, 81% responded that vaccination should be a personal decision.

Two-Thirds of Spouses Willing to Get Separate Plans, But May Not Know How

Perhaps the reason that the largest percentages of both groups surveyed would choose to pay the extra $200/month is that they aren’t aware of any better alternatives. Sixty-six percent of people receiving insurance through their spouse said that they would consider getting a separate policy if faced with this situation, but only 10% of the employees providing health insurance for their partners say they would choose to stay on the plan without their spouse.

Additionally, 37% of respondents receiving insurance through their partner say they wouldn’t know where to go for health insurance if they weren’t on their spouse’s plan, and only 51% say that they’ve even heard of split-family insurance plans. “Many couples are simply not aware that it’s okay to get separate health insurance policies,” says Ali. “In fact, most times, it serves them even better because it ends up being more cost-effective, depending on the source of the policy.”

Although $200 extra/month is a hefty fee, the majority would still elect to pay this over their spouse getting vaccinated or dropping from the plan. This resolve could be due to multiple reasons, such as not knowing how else to receive insurance or a staunch belief that vaccines are a personal choice. If more companies begin to enact such policies, employees may become accustomed to the practice and be more willing for spouses to get vaccinated. Until then, we’ll have to wait and see how this affects Ochsner and Delta employees in the coming months.

Survey Methodology

This survey was commissioned by and conducted online by the survey platform Pollfish between October 7, 2021, and October 8, 2021. In total, 1,000 participants in the U.S. were surveyed: 500 employees providing health insurance to their unvaccinated spouse and 500 unvaccinated spouses receiving health insurance through their partner’s employer. Participants had to pass through two screening questions and demographic filters to ensure they were qualified for the survey. Please contact [email protected] for the full survey data.