Can You Have 2 Health Insurance Plans?

Having two health insurance plans simultaneously, known as dual coverage, is permissible in the United States. While it doesn’t mean double benefits, specific rules determine how each plan contributes to covering medical costs, ensuring expenses are allocated appropriately and preventing overpayment. This article explains how dual coverage functions.

Understanding Dual Coverage

Dual health insurance coverage can arise from various life circumstances. Common scenarios include:
Married couples where both partners have employer-sponsored health plans, and one spouse is covered as a dependent on the other’s plan.
An individual with an employer-sponsored plan who also enrolls in an individual plan, such as one from a Health Insurance Marketplace.
An employer-sponsored plan alongside Medicare, often for individuals working past age 65.
COBRA coverage combined with a new employer’s plan or an individual plan.
Medicaid or the Children’s Health Insurance Program (CHIP) in conjunction with a private health insurance policy.

How Coordination of Benefits Works

When an individual has two health insurance plans, Coordination of Benefits (COB) determines which plan pays first. COB rules prevent duplicate payments and ensure total payment does not exceed 100% of allowed medical expenses. One plan is designated as the primary payer, processing the claim first according to its benefits.

After the primary plan pays its share, remaining eligible costs may be submitted to the secondary payer. The secondary plan reviews the claim and may cover some or all of the remaining balance, applying its own benefit structure, including deductibles, copayments, and coinsurance. It does not simply pay whatever the primary plan did not.

Rules for determining the primary plan vary by situation:
Own Employer Coverage: If you have coverage through your own employer and are also a dependent on another plan (e.g., spouse’s), your own employer’s plan is usually primary.
Dependent Children (Birthday Rule): For children covered by both parents’ plans, the plan of the parent whose birthday falls earlier in the calendar year is typically primary. For example, if one parent’s birthday is in March and the other’s is in August, the March birthday parent’s plan would be primary.
Divorced/Separated Parents: Court orders may dictate which parent’s plan is primary. If no order exists, the birthday rule or the custodial parent’s plan may apply.
Medicare Involvement: Medicare typically acts as the secondary payer if an individual has an employer-sponsored group health plan with 20 or more employees. For employers with fewer than 20 employees, Medicare is generally primary.
COBRA Coverage: If you have COBRA and enroll in a new employer’s plan, the new employer’s plan is usually primary.
Medicaid/CHIP: Medicaid is often the “payer of last resort,” paying after all other insurance sources.

Managing Costs and Claims

Dual coverage can reduce out-of-pocket medical costs but requires paying two sets of premiums. Weigh combined premium expenses against potential savings on deductibles, copayments, and coinsurance. While the secondary plan may help cover cost-sharing, deductibles for each plan must still be met separately.

Claim processing with dual coverage can be more complex and take longer. Providers submit claims to the primary insurer first. After the primary insurer processes the claim and provides an Explanation of Benefits (EOB), the remaining balance and EOB are submitted to the secondary insurer for review and payment.

Carefully review the Explanation of Benefits (EOB) from both insurers. These documents detail what each plan paid, what was applied to your deductible, and your remaining responsibility. Reviewing EOBs ensures claims are processed correctly and prevents overpayment.