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Spring 2021  Volume 14, Number 1        
 

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Pros and Cons of Having Two Health Insurance Policies

If having one health insurance policy is good, is having two even better?

There are advantages to having double or multiple policies, but it's not a guarantee that all your expenses will be covered. So, before paying for more than one policy, it's important to understand how dual coverage works.

First, it is legal to have more than one plan, and there are a variety of reasons why you might have more than one. For instance, if you're:

  • Under age 26 and have coverage through your parents and your employer.
  • Married and have coverage through your and your spouse's employers.
  • Under 26 years old with married parents who have you covered under both their plans.
  • Under 26 and you're married and covered by your spouse’s plan and one of your parents' plans.
  • Covered under a health insurance plan and receive Medicaid coverage.

How it Works

If you have more than one plan, first make sure that the doctors you are seeing are covered by both plans.

Your primary insurance will pay first, up to your coverage limits. Determining which of your policies is primary insurance depends on the situation. For example, if you're:

  • Covered under insurance by both your parents, primary coverage will come from the parent whose birthday comes first in the calendar year (age has nothing to do with it).
  • Under 26 and covered by your school/employer’s plan and your parents’ health plan, then your school or employer-sponsored coverage is primary.
  • Married and both you and your spouse have coverage through your employers, your employer’s coverage is primary.
  • Under 26 with divorced parents who both cover you under their separate policies, the parent who has custody is the primary coverage. If both parents have joint custody, the birthday rule applies.
  • Under 26, married and covered by both your spouse's plan and your parents' plan, then your spouse's plan is primary.
  • Covered under a health plan and receive Medicaid, your health plan pays first.
  • Covered under Medicare and a private health plan, then Medicare pays first if your employer has fewer than 20 employees.

After your primary insurance pays its portion, you will still need to cover any deductibles, cost sharing or out-of-pocket expenses, such as copayments or coinsurance. But your secondary insurance kicks in once your primary insurance has paid its share. Your secondary insurance may cover part or all of the remaining cost if the procedures or services are deemed covered and necessary.

It's important to remember that both the primary and secondary insurance will only cover up to plan limits. You may be responsible for any remaining amount that wasn't covered.

In addition, if your primary insurance is a HMO (Health Maintenance Organization) plan, and you see a provider who is out-of-network, your primary insurance won’t cover the costs AND your secondary insurance won’t cover the costs either because you didn’t follow the primary plan's rules.

Pro

If you're prone to illness, then dual or multiple coverage can help reduce your health care costs. Plus, if you have two plans, you don’t need to worry about being uninsured if you lose your job and employer-sponsored health insurance.

Before deciding to take this route, it’s important to estimate whether the cost of paying premiums under two plans and incurring two sets of deductibles would outweigh the extra coverage of having two plans.

Cons

Having dual coverage may require more paperwork if a health plan denies a claim or pays less than you expected.

Plus, you'll have to deal with two insurance companies. Each company's plan could have a different design, such as a preferred provider organization (PPO) and health maintenance organization (HMO) plan. Or one plan may agree to pay for a test or prescription, while the other may deny it.

You'll need to make sure all of your providers accept both plans and that you follow the in-network guidelines, if applicable.

Because of deductibles and other plan features in the dual policies, you may still not be able to have all your costs covered.

 

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In this issue:

This Just In...

Congress Takes the Surprise Out of Surprise Billings

Pros and Cons of Having Two Health Insurance Policies

The Increased Importance of Life Insurance During the Pandemic

Social Security Adjustments for 2021

 


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