Though money and matrimony have been linked since Genesis, marrying for health coverage is a more modern convention. For today’s couples, “in sickness and in health” may seem less a lover’s troth than an actuarial contract. They marry for better or worse, for richer or poorer, for co-pays and deductibles.

Bo and Dena McLain of Milford, Ohio, eloped in March so he could add her to his group policy because her nursing school required proof of insurance. Corey Marshall and Kim Wetzel, who had dated in San Francisco for four years, moved up their wedding plans by a year so she could switch to his policy after her employer raised premiums

Ms. Brady and Mr. Huggins concede that their discussions about marriage have been freighted with cost-benefit analysis.

Ms. Brady learned three years ago that she had end-stage renal disease and after two years of dialysis received the transplant in May 2007. Her medical costs remain substantial and unpredictable. The demands of dialysis forced her to give up a much-loved job as a store manager for the Body Shop, and she eventually lost her insurance.

She now receives a Social Security disability check of $1,181 a month, and spends $95 of that on premiums for Medicare, the federal health insurance program for the elderly and disabled, which insures kidney transplant patients for up to three years.

With Medicare covering only 80 percent of most charges, however, Ms. Brady still has been left with thousands of dollars in bills.

Until this spring, Ms. Brady filled the gaps with a supplemental policy bought from State Farm. In April, she received notice that the premium was more than doubling, to $2,621 a quarter, from $1,180.