Marriage for Health Insurance: A Creative Solution Amidst Rising Costs
Marrying a roommate for insurance? Some Americans are making big leaps to manage the cost of health care. Anton Pentegov/iStockphoto/Getty Images
For Mathew, the decision to marry his best friend to secure health insurance feels surreal. “I find myself in the middle of some sort of rom-com plot,” says Mathew. Marrying Christina, his platonic friend, was a strategic move to continue accessing necessary healthcare for his autoimmune disease.
Mathew, who asked NPR not to reveal his full name, married Christina to remain insured after the expiration of enhanced subsidies under the Affordable Care Act (ACA) left him facing unaffordable premiums. His story is not unique, as many Americans have historically tied marriage to health insurance, especially before the ACA.
The lapse in subsidies has left about 24 million people facing a healthcare cost crisis, with monthly premiums soaring. While Congress is negotiating a solution, individuals like Mathew are forced to make drastic lifestyle decisions to maintain insurance coverage.
“That’s so weird”
Living in Michigan, 40-year-old Mathew has relied on ACA for his health coverage, with a manageable premium of $181 per month in 2025. When he learned his costs would more than double, he faced a tough choice.
Christina, his roommate of 25 years, proposed marriage to provide him with access to her employer-sponsored insurance. “We met when we were in eighth grade and have been living together ever since,” he recalls. Although initially hesitant, Mathew accepted the offer after considering their longstanding friendship and shared responsibilities.
In September, they held a small wedding ceremony, allowing Mathew to secure a health plan costing $121 per month. Now, he’s in a race to transition his medical care under the new insurance.
Many reasons for marriage
Erin Fuse Brown, a health law professor at Brown University, notes that marrying for benefits was more common before the ACA. With the expiration of enhanced premium tax credits, she suggests there may be a resurgence of such arrangements. “Marriage for benefits is not against the law,” she clarifies, adding that people marry for various non-romantic reasons.
Despite his unconventional marriage, Mathew remains hopeful that Congress will restore subsidies for the ACA, acknowledging that not everyone has a friend they can marry to obtain affordable health insurance.
