Can I Use Two Health Insurance Plans?

It is common for individuals to have coverage under more than one health insurance plan. This situation is generally permissible and can offer additional benefits. However, utilizing multiple plans involves navigating specific rules and processes to ensure proper payment for healthcare services.

How Health Insurance Plans Coordinate Benefits

When an individual has more than one health insurance plan, a process known as Coordination of Benefits (COB) comes into play. COB is the mechanism insurance companies use to determine how two or more plans will work together to cover medical expenses. This process prevents individuals from receiving payments that exceed 100% of the total cost of their medical services, thereby avoiding duplicate payments or overpayment.

COB establishes which health plan pays first and what portion subsequent plans will cover. Each insurance policy includes specific COB provisions outlining how it interacts with other existing health coverage. Insurers communicate to process claims according to these rules.

Once the primary plan processes a claim and pays its portion, the secondary plan reviews the remaining balance. The secondary plan may cover some or all costs not paid by the primary plan, such as deductibles, copayments, or coinsurance, within its own coverage limits.

Determining Primary and Secondary Coverage

If you are covered by your own employer-sponsored plan and also as a dependent on a spouse’s plan, your own employer coverage is primary. For children covered by both parents’ health plans, the “birthday rule” applies. This rule designates the plan of the parent whose birthday falls earlier in the calendar year (month and day) as primary, regardless of the birth year.

When COBRA coverage overlaps with active employee coverage, the active plan is primary. For individuals with Medicare and employer group health plans, Medicare’s primary or secondary status depends on the employer’s size. If the employer has 20 or more employees, the employer group health plan pays first for individuals aged 65 or older. If the employer has fewer than 20 employees, Medicare pays first. Medicaid functions as the payer of last resort, meaning other available coverage, including private insurance or Medicare, must pay claims before Medicaid provides payment.

Common Situations for Multiple Health Plans

Individuals often find themselves with more than one health insurance plan due to various life circumstances. One frequent scenario involves spousal coverage, where both partners have employer-sponsored health plans and may also cover each other or their family members. This arrangement can lead to dual coverage for the entire family.

Children are commonly covered by multiple plans, particularly when both parents have separate health insurance. In such cases, children might be listed as dependents on both parents’ policies. Additionally, young adults under the age of 26 may have their own employer-sponsored or student health plan while remaining covered as dependents on a parent’s plan.

Other situations include individuals transitioning between jobs who might have COBRA continuation coverage alongside new employer-provided insurance. People eligible for Medicare may also retain employer coverage, retiree benefits, or have Veterans Affairs (VA) benefits. Similarly, individuals who qualify for Medicaid might also have private insurance.

Managing Your Healthcare with Two Plans

Successfully managing healthcare with two insurance plans requires understanding the claims process and your financial responsibilities. Claims for medical services are submitted to the primary insurer first. After the primary insurer processes the claim and pays its portion, the remaining balance is then submitted to the secondary insurer.

The primary insurer often sends the Explanation of Benefits (EOB) directly to the secondary insurer. You may need to provide the EOB from your primary plan to your secondary plan yourself. The secondary plan then reviews the claim and may cover additional costs, such as deductibles, copayments, or coinsurance, reducing your out-of-pocket expenses.

Communicating with your healthcare providers is important. Inform your provider’s office about all your insurance plans so they can correctly identify the primary and secondary payers and submit claims in the proper order. Regularly reviewing the EOBs from both plans helps ensure claims have been processed accurately and allows you to understand what each plan has paid and any remaining amounts you may owe.