Having two health insurance plans is legal and happens more often than you might think.
In fact, there are a variety of reasons you might have two plans:
- You’re on Medicare and are also covered by your employer.
- You’re married and have a policy with your employer but are also on your spouse’s plan.
- You have health insurance and also receive Medicaid coverage.
- You’re under 26 and have insurance through your employer as well as your parents’ health insurance.
- You are an injured worker with health insurance and qualify for worker’s compensation.
- You’re an active member of the military covered by your own health insurance and the military’s plan.
What Do You Need to Know?
If you have two forms of health insurance, the primary pays the first portion of your bill, and the secondary may pick up some or all of the remaining cost. It’s important to understand that you may still be responsible for part of the bill, such as the deductible on your primary insurance (secondary insurance may not pay for this).
A process called coordination of benefits (COB) decides which plan pays first and which pays second. This might be set up by the federal government, your state government, or your employer.
In number one above, Medicare is considered primary if your employer has 100 or fewer employees, otherwise the private insurer is primary. In number two, your employer is primary, and your spouse’s plan is secondary. In number three, Medicaid is secondary to any other plan. In number four, your plan is primary, and your parent’s plan is secondary.
In number five, worker’s compensation is primary. In number six, your insurance plan is primary, and military coverage is secondary (except if the other plan is Medicaid).
To ensure both plans review claims for payments, present both member ID cards to your provider. Then, when your explanation of benefits arrive via email or snail mail, review them to ensure the benefits were applied accurately.
