People shopping for health insurance are often seen confused between two health plans and guess whether they can have two health insurance plans or not. However, people should know that it is perfectly legal to have two health insurance plans and many people have two health plans under certain circumstances.
The Need to have Two Health Plans
There are different reasons and circumstances under which people may have two health insurance plans.
- An individual who is an adult child under the age of 26 years may be receiving health coverage through their parent’s plan and through his/her employer.
- A couple receiving health insurance through their respective employer as well as partner’s employer.
- Individuals having two parents and both the parents have included him/her as a dependent under their plan.
How the Two Plans Work Together?
By having two health insurance plans individuals will not get reimbursed twice for receiving a healthcare service or purchasing a drug. Individuals having two health insurance plans receive coverage through the coordination of benefits process. In this process, one health plan becomes the primary, and the other plan becomes secondary. The plan which an individual receives through an employer is his primary plan. However, if a child is having two health plan through his/her two parents who include the child as their dependent under their family plans, then his primary plan will be from a parent whose birthday arrives first in the calendar year. Birthday rule is used to determine the primary and secondary plan of the child.
If the individual with two health plans makes a health insurance claim, then his primary plan will provide him with all the benefits covered under the plan, as if the individual had no secondary plan. After the benefits of the first plan are availed then the secondary plan kicks in to cover the remaining cost if it is covered under the plan and is necessary. Individuals should keep in mind that they will have to pay a deductible of both their plans and their secondary insurance plan cannot pay towards their primary deductible.
Irrespective of the fact that whether individuals have one or two plans, insurers follow the same coverage rule and pay in the same manner for the healthcare received. It means that despite having two health plans, individuals might end up paying an out-of-pocket cost. A situation in which individuals may have to pay an out-of-pocket cost is when they receive healthcare from a provider who charges more than what their insurer may consider reasonable or customary. As insurers pay for only the reasonable cost, an individual’s secondary plan would not be required to pay for something, which they feel unreasonable.
Benefits of Duel Coverage
- By having two health insurance plans, people will have dual coverage and will have access to both of their plans to cover their healthcare costs, thereby saving their money.
- The combined coverage for people having two plans cannot exceed 100% of the cost. This means that people may not have to pay an out-of-pocket expense, or if they pay also then it is less than what they would have to pay if they had only one plan.
- People who have second coverage through their parent’s or partner’s plan are also tension-free, as they don’t have to worry about going uninsured in case they lose their job and health insurance or if they choose to change jobs.
Does the Idea of Having Two Health Plan is Beneficial?
People should think of having two health plans, as it is the best way to maximize benefits and receive more coverage compared to having only one plan. There is quite a good chance that people can stay covered under their parent’s or partner’s insurance at little or no cost to them because some employers offer coverage to the family at a flat rate and not based on per dependent. However, if people think that they could save money by waiving heir access to a plan, then they should consider how the coordination of benefits functions. People should also consider the medical care they received in the past with the dual health plans, and the care they may need in the future.