Can you have coverage through two health insurance plans? Is it even legal? Read on to learn about primary and secondary insurance.
Yes. You can have two health insurance plans! Having two health insurance plans is perfectly legal and many people have two under certain circumstances.
Why would I have two plans?
There are a few different reasons why someone might have two health insurance plans:
- You are an adult child (under the age of 26) who receives coverage through their parents and their employer
- You are a couple who both receive health insurance through their respective employers
- You are a child with two parents that have health insurance and have you as a dependent under their respective insurance plans.
How does having two plans work?
Having two insurance plans doesn’t mean you get reimbursed twice for a doctor’s visit or two bottles of medication.
Coordination of benefits is the process in which someone with two health insurance plans can receive coverage.
The way that this works is that one plan becomes your primary and one plan becomes your secondary. Your primary plan will be the plan that you receive through your employer.
If you are a child with two parents who insure them under their respective family plans, your primary is decided by something called “the birthday rule”. Your primary insurance plan will come from whichever parent whose birthday comes first in the calendar year.
|Your employer-sponsored plan||Your parent’s plan|
|Your employer-sponsored plan||Your spouse’s plan|
For a child covered by respective family plans, use the birthday rule to determine their primary and secondary insurance.
In the event you make a health insurance claim, your primary insurance plan will act as if you had no secondary plan and provide you with your benefits. Then your secondary insurance plan kicks in and covers the rest of the cost if it’s covered and necessary.
Keep in mind that you will have to pay both deductibles for your plans. Your secondary insurance cannot pay toward your primary’s deductible.
Regardless of whether you have two plans, health insurance companies still follow the same rules regarding how they pay for the care you receive. This may mean that even though you have two plans you could still end up paying an out-of-pocket cost.
An instance in which you may have to pay an out-of-pocket cost would be if you received care from a provider charging more than what your insurance company(s) may consider reasonable or customary. Since your insurance only pays for what they believe to be a reasonable cost, your secondary plan would not be required to pay for something if they felt it was unreasonable.
Benefits of Duel Coverage
Having two health insurance plans often means saving money. Having duel coverage allows people to have access to both of their plans to cover their healthcare costs.
The combined coverage cannot exceed 100% of the cost, however this means that people with two plans may not have to pay an out-of-pocket expenses or if they do it’s less than what they would have to pay with only one plan.
Additionally, since you have coverage through your parent’s plan or your partner’s plan you don’t have to worry about going uninsured if you lose your job and the health insurance that comes with it or choose to change jobs.
Should you keep two health insurance plans?
Having two health insurance plans is a fantastic way to maximize benefits and potentially receive more coverage if you only have one plan.
There is a good chance that you can stay covered under your parent’s or spouse’s insurance at little to no cost to them (some employee-sponsored plans offer family coverage at a flat rate, not per dependent).
If you think you could save money by waiving your access to one plan, consider how the coordination of benefits functions, the medical care you’ve received in the past, and the care you may need in the future.