Yes, it is perfectly legal to have more than one health insurance plan. With the coordination of benefits, it can work to your advantage. If you have access to two health insurance plans, it can increase your coverage and save you money.
Why Do Some People Have More Than One Health Plan?
People can end up with more than one health plan in a variety of circumstances:
Married couples or domestic partners who each have health insurance through their employers may both include each other under their plans.
Adult children under the age of 26 may have health coverage through their parents and also through their employers.
Children with two parents who have health insurance may be covered under both plans.
Married, adult children under age 26 may be covered under both their parents’ and their spouse’s plans.
How Does It Work With Multiple Health Insurance Plans?
You don’t get double benefits if you have two health insurance plans. The total combined amount your plans pay out will never exceed 100% of the cost of your care. A process called coordination of benefits determines which of your plans pays first for a particular claim. One health insurance plan is considered primary, and the other is secondary.
Primary insurance pays first, up to policy limits. You may have a copay or cost-sharing. The primary health plan is required to pay everything it would pay, regardless of any secondary plan.
Secondary insurance applies to the remaining balance after your primary insurance has paid its portion. This plan may cover all or a portion of the remaining costs. Secondary plans may take the health insurance benefits provided by the primary plan into consideration, after which remaining allowable costs are considered for payment.
Both primary and secondary health insurance will only cover up to plan limits. Even after both plans have paid, you may have out-of-pocket expenses remaining.
Will I Still Have Deductibles With More Than One Health Plan?
If you have multiple health plans, you still have deductibles. Your secondary plan will not cover the deductible for your primary health plan. You may also be responsible for copayments or coinsurance. Plan rules still apply when you have more than one health insurance plan. For example, if you go to an out-of-network provider not covered by your primary insurance, your secondary insurance will not cover the costs.
What About Charges Not Considered “Reasonable and Customary?”
Health insurance plans will only cover amounts they deem “reasonable and customary.” If services or supplies are billed at a higher cost, primary health insurance will not cover the full amount. The secondary health plan is not required to pay the balance. The patient may have to cover it out of pocket.
There are pros and cons of having more than one health insurance plan. The main disadvantage is premiums have to be paid for all plans. The main advantage is extra coverage for medical costs. If you have questions about multiple health insurance plans, speak with our experienced agent.