It might seem like a strange situation to be in when you find yourself covered in the same way by two different health insurance plans.
This can happen if you’re an adult still young enough to be on your parent’s health insurance plan but also have health insurance from your employer. It can also happen if you opt-in to your employer’s health insurance plan while choosing to keep your individual or family plan active. As a final example, you might have canceled your current policy but there’s a period of time where your remaining coverage overlaps with your new policy.
When it comes to insurance, however, twice isn’t always so nice – mostly because it can be a headache getting through the coordination of benefits. This is the process where you have to decide which health plans are your primary and secondary insurance, and if both plans can provide the same type of coverage for a particular claim.
In an ideal scenario, when the first plan can’t cover the full cost of services, the second one kicks in to contribute. Where Plan 1 covers a healthcare service or product – like mental health services or birth control – and Plan 2 doesn’t, then Plan 1 is the only relevant plan for that particular claim.
Insurance companies also have their own unique rules and policies that govern the coordination of benefits, so it’s vital to understand how both of your insurers handle this matter. In an entirely possible scenario, seeking coverage from both plans on a single claim can result in a denial of benefits from both.
The elephant in the room, of course, is what it costs to have two health insurance plans in place. If you are paying both premiums, this can be incredibly costly, to say the least. Even if you keep your private plan and go onto your employer’s, affording your existing premiums can mean losing income over a product that may have conflicts with the second plan.
Reasonable & Customary Costs
Even if you can manage to pay the premiums of an additional health insurance plan, it’s no guarantee that you’ll escape out-of-pocket costs. Insurance providers follow the same rules in how they assess and pay for claims when their customer has two plans. These rules include covering only what is a reasonable or customary cost for a medical service or supplies.
When a health care provider bills insurance for something that exceeds reasonable or customary costs, the insurance company is likely to only pay a portion of the full bill – potentially leaving their customer to afford the remainder.
You might think that your secondary insurance would kick during such a situation, but this isn’t always so. Once the reasonable and customary amount is paid by the primary insurance, the secondary insurance isn’t obligated to pick up the tab.
Conclusion
Having two concurrent health insurance plans can be useful when two plans don’t have a lot of overlap in coverage, but beyond this, they can be a bit of a hassle. Sometimes, simply upgrading your insurance plan can offer the benefits and privileges that two lesser plans may have.
If you’re thinking about individual healthcare insurance for you or your family, reach out to Insurance Specialists, Inc. to learn more about our products and services. Get in touch with us today by contacting us online!