Can you have Two Health Insurance Plans?

Having two health insurance plans can be a real deal for your patients in terms of coverage and less out-of-pocket health insurance cost. Yes, the patient can have two health insurance plans, but that doesn’t mean you get compensated twice for a visit or medication. The patient has two health insurance plans, which the insurance company pays first resolute by using a coordination of benefits provision.

What is Coordination of Benefits?

When a person has two health insurance plans one is primary and other is secondary. Coordination of benefit decides which plan is primary and which is secondary. To elaborate, if your partner has family health insurance coverage and you also have a health insurance policy at work. In this case, you can have access to your plan and your partner’s health insurance plan through coordination of benefits provided to have more coverage limits for care. However, you must be aware of how to deal with the potential confusion that comes with COB regulations.

How does Coordination of Benefits or Dual Health Insurance plans work?

The primary plan pays its share of the costs first. Then, the secondary insurer pays up to 100% of the total cost of treatment, as long as it’s covered under the plan. 

Primary Health Plan

The health insurance that pays first is the primary plan and will pay up to the coverage limits decided by a state or the federal government under COB guidelines.

Secondary Health Plan

Once the insurer has paid his share as per the plan limits and there’s still leftover, it goes to your secondary insurer. It will cover the remaining cost of what it owes as per the regulations. Paying through both of your health insurance policies, if there is still money left on the bill, the member has to bear the out-of-pocket medical cost.

Special Cases With Patients Having Dual Coverage

Primary vs. secondary is entirely dependent on who pays first for most likely situations.

• Adult children under 26 – As per The Affordable Care Act, adult children under 26 can stay on the parent’s health plan, who have coverage by the school, employer, and parents, in that case, the school or employer is the primary insurance, and the parent’s plan is secondary.
• Married couples – If each of you has access to a health insurance plan through your employers, in this case, your employer’s coverage is primary, and your domestic partner’s employer coverage is secondary.
• Married parents with separate policies and a child under 26 are on both plans – In this situation, the birthday rule is applicable. The parent who has the earlier birthday in a calendar year would be considered primary, and the other partner whose birthday comes second in a calendar year is secondary. It is not related to which parent is older.
• Private Health plan & Medicaid – Private health plan as primary if the employer has more than 100 employees and Medicaid coverage as secondary.
• Married adults under 26 and covered under both, the spouse’s and parents’ plan – In this case, your domestic partner’s coverage is your primary insurer, and your partners are the secondary insurer.

Important Points to Consider

• Dual coverage can help with healthcare costs and a way to maximize benefits. However, there are also some potential confusions of having two health insurance plans. The best strategy in such cases would be to identify the primary insurer, even before providing services to the patient, to avoid payment delays.
• The Affordable Care Act prefers medical over dental, and the medical is usually primary.
• As for divorced parents, the court determines the coverage for the plan. The parent with custody is primary, and w/o child custody is secondary if applicable. With joint guardianship, the birthday rule is applicable.
• If your patient has several active employer’s coverages, in that case, the health insurance plan that has offset the employee the longest is considered as primary. Prior employment cases standardized by COBRA, and the health insurance that indemnifies the patient as a current employee is primary.