According to work-family conflict (WFC) theory, fathers in full-time employment are in better health than jobless/part-time fathers across institutional contexts in Europe, while mothers in full-time employment are in worse health than jobless/part-time mothers in countries with insufficient institutional support, but in better health elsewhere. In this paper we test whether “couple-level work arrangements” (dual earner, male breadwinner, female breadwinner) also matter today for mothers’ and fathers’ health, on top of their individual work situation, leading to some departures from WFC predictions. As dual earner (DE) families become more widespread, the male breadwinner (MB) arrangement may have become less attractive across contexts, leading to negative selection into such arrangements and worse health for mothers in conservative contexts and perhaps for fathers in progressive contexts. Concomitantly, the female breadwinner (FB) family model, while gaining in numerical weight, may encounter forms of societal resistance in more conservative settings, negatively affecting mothers’ double burden and health compared to DE mothers. Using European Social Survey data (2004–2018, 31 countries), we compare the self-rated health of mothers and fathers (with children below age 13) in DE, MB and FB couples across different welfare state contexts, controlling for income. We find, as expected, that MB mothers nowadays rarely exhibit a health advantage, even in less supportive institutional contexts in Europe; on the other hand, there is still no health disadvantage for fathers in MB families, even in more progressive countries. FB mothers are in worse health than DE mothers only in Eastern European countries. These results are robust to various specifications regarding couple-level work arrangement categories, country typology, or sample used.