Publicist Brian Erni, of St. James, works for a company that would extend health insurance to his wife if he would pay for it. The problem: It costs $900 per month to add her to his plan.

Many companies plan to trim, eliminate or charge extra for benefits for employees' spouses in 2014, when key parts of the Affordable Care Act take effect. Meanwhile, the advent of health insurance exchanges, which opened to consumers Tuesday, provides some new options.

Previously, a family might have bundled its health insurance under one adult's plan in order to save money. Now, they will have to figure out the new math on how best to cover family members. It will often add up to sending spouses in different directions for coverage and sometimes to different doctors.

For slightly less than $400 a month, Erni's wife, Lauren Barresi, 26, can now sign up for a bronze-level plan with a $3,300 deductible, according to estimates on And a quote from private insurance marketplace shows a comparable offering on the open market would cost more than $600, still less expensive than the employer surcharge.

Families should do some comparison shopping. Here are some scenarios:

Two workplace plans: For two working spouses, being on different plans might not be that jarring if the offerings are fairly equal.

Financial planner Bryan Bly, 47, has done the math for the past 11 years to see what arrangement is best for him and his wife, 48 -- and whose plan is better for their 9-year-old daughter. They did this even before Bly's employer in Atlanta began two years ago to put a surcharge on medical benefits for spouses who are employed.

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"The difference annually was in the hundreds of dollars range," Bly says.

If your employer makes this move to curtail family plans, be prepared to show documentation that your spouse is not otherwise covered and that you are legally married.

One worker covered: For companies that are adding hefty surcharges or not covering spouses at all, the uncovered spouse will have options on the open market or on the new public health insurance exchanges. These spouses, however, won't qualify for subsidies on the exchanges because one member of their household has a workplace plan.

Scanty coverage: If you are not happy with your workplace options, you can go out into the market and shop around, just without subsidies. While dependents are still covered under workplace plans up to age 26, families may consider getting them their own coverage, particularly if they are healthy young adults.