Yes, it is perfectly legal to have more than one health insurance plan. With the coordination of benefits, it can work to your advantage. Having access to two health insurance plans can increase your coverage and save you money.
Why do some people have more than one health plan?
People can get more than one health plan under different circumstances:
- Married couples or domestic partners who each have health insurance through their employers can both include each other under their plans.
- Children with two parents who have health insurance can be covered according to both plans.
- Married, adult children under the age of 26 may be covered by both their parents' and their spouse's plans.
How does it work with multiple health insurance plans?
You do not receive double benefits if you have two plans for health insurance. The total amount that your plans pay out will never exceed 100% of the cost of your care. A process called benefit coordination 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 insurance limits. You can have a copy or cost sharing. The primary health plan is obligated to pay everything it would pay, regardless of the secondary plan.
- Secondary insurance applies to the remaining balance after your primary insurance has paid its share. This plan may cover all or part of the remaining costs. Secondary plans may take into account the health insurance benefits provided by the primary plan, after which the remaining allowable costs are taken into account for payment.
Both primary and secondary health insurance only cover up to plan limits. Even after both plans have been paid, you can still have your own expenses.
Do I still have deductibles with more than one health plan?
If you have multiple health plans, you still have deductibles. Your secondary plan does not cover the deductible for your primary health plan. You can also be responsible for co-payments or co-insurance. Plan rules still apply when you have more than one health insurance plan. For example, if you go to a provider outside the network that is not covered by your primary insurance, your secondary insurance will not cover the costs.
What about fees that are not considered "reasonable and ordinary?"
Health insurance plans only cover amounts that they consider to be "reasonable and ordinary." If services or deliveries are invoiced at a higher cost, the primary health insurance does not cover the entire amount. The secondary health plan is not required to pay the balance. The patient may need to cover it out of pocket.
There are pros and cons to having more than one health insurance plan. The main disadvantage is that premiums must be paid for all plans. The biggest benefit is extra coverage for medical costs. If you have questions about multiple health insurance plans, talk to our experienced agent.