Finding one insurance plan that’s right for you can seem like a big task. But in some cases, you might actually be wondering if it’s possible to have two health insurance plans. And the answer is yes: it is possible and legal to have two policies, a primary and secondary health insurance policy. And while it might seem like a lot of extra work to research and maintain two plans, having two different health insurance plans can actually help you save money on the overall cost of your medical care and treatment.
With that being said, having two plans can also mean paying twice as much each month for your premiums. As well as twice as much for your deductible. So if you are considering purchasing additional coverage, you’ll need to give serious thought to whether or not enrolling in a second health insurance plan would be the best option for you.
To help you make this decision, we’ve broken down how primary and secondary insurance policies work. So you can understand the difference and get a better idea of how two policies could work for you. And, as always, if you have any questions, or need help looking for the right policy – or policies – for you, contact an EZ agent!
Primary Insurance
Your primary plan will be the plan that will first cover any necessary medical care. This plan will pay before your secondary insurance plan kicks in. For instance, if you need to see a doctor or buy prescription drugs, your primary insurer will cover the costs of these services up to the coverage limits that it provides. Remember, though, as with any health insurance plan, you may still be responsible for cost-sharing, like coinsurance.
Secondary Insurance
In most cases, if you have a secondary insurance plan, it won’t begin to pay out benefits until after your primary insurance plan has exhausted its available coverage. After your primary insurer has paid its share of your medical costs, your secondary plan will begin to take effect to cover any additional costs that remain.
How to Get Two Plans
Getting secondary health insurance is similar to getting primary health insurance, but there are some differences to keep in mind. Here are the steps to getting a second policy:
Assess your primary policy – Review the policy documents for your current plan to find out what services are covered, how cost-sharing works, and what coverage limits there are. Think about your current and future health needs to find any gaps in your coverage.
Research secondary options – Options for secondary coverage range from plans that cover just one type of health service to plans that cover everything. Find out what kinds of plans are available to you and choose the one that fills in the gaps in your current coverage the best.
Understanding coordination of benefits – People can’t choose which of their two health plans is the “secondary” one. Before you sign up for another plan, make sure it will pay after the one you already have.
Apply and purchase – To sign up, follow the instructions for the plan you’ve chosen. Fill out the forms carefully and be ready to answer questions about your current health insurance. Pay your first month’s premium after getting approved for coverage.
How Does Having Two Plans Work?
When you have a medical bill, the first insurance that pays out is your primary insurance. It will pay up to its coverage limits. Then your secondary insurance will kick in and can pay part or all of the remaining costs. Please be aware that there are limits to the coverage provided by both the primary and secondary insurance. If the secondary insurer does not pay in full, the remaining balance will be your responsibility. Therefore, it is possible that you will have some remaining out-of-pocket medical costs. Even if you carry multiple health insurance policies.
There is a good chance that a Coordination of Benefits clause is included in your health insurance policy. This clause will lay out the predetermined order of how your plans will pay for your covered services. So, in the event that you or your medical provider file a claim for your care, the Coordination of Benefits document will specify which plan is accountable for making payments.
Examples of Primary and Secondary Plans
So, if you have more than one insurance policy, which policy is considered primary and which is considered secondary will be determined by your circumstances. The following are some examples of how primary and secondary plans work for different groups of people:
Married Couples – Say a wife has her own insurance but she is also covered under her husband’s group insurance from his job. The wife’s primary insurance would be her individual plan and her husband’s group coverage would be the secondary.
Minors under 26 – Under the Affordable Care Act, dependents can remain on their parents’ insurance until age 26. This means that an adult under this age could get their own health insurance policy from their employer while still being covered by the family policy. If that’s the case, the child’s health insurance would be the primary plan. And the parent’s would be the secondary plan.
Parents with separate plans – Say you are under 26 and still on your parent’s health plan. If they both have separate plans and you’re listed on both of them, you have dual coverage. The primary and secondary coverages are determined by a “birthday rule”. Meaning whichever parent’s birthday is earlier in the year will give you your primary insurance. And the one with the later birthday will give you your secondary plan. For example, if your mom’s birthday is in January and your dad’s birthday is in March. Your Mom’s insurance would be your primary coverage. This isn’t about which parent is older – the birth year doesn’t affect the order, only the birth month.
Medicare beneficiaries with group health plans – If you are 65 or older and on Medicare, but are still working and have insurance through your employer, Medicare will be your primary insurance if the company you work for has fewer than 20 employees. If your company has 20 or more employees, your group plan will be primary and Medicare will be secondary.
Out-Of-Pocket Costs
The cost of having two plans will generally be higher than the cost of having one plan. Since you will have to pay the premiums and deductibles for each of your health insurance policies. For example, consider this: you will not be able to use your secondary coverage to cover your primary’s deductible. You will also have to pay any copayments and coinsurance that are associated with each plan.
It’s also important to note that the rules of your primary plan will apply to both of your policies. So, for example, if your primary plan is a PPO plan. Your primary policy may stipulate that you can only use certain doctors and hospitals in your plan’s network. Your primary insurance won’t pay anything if you go to a doctor who isn’t in their network. The secondary insurance won’t either because you broke the primary plan’s rules by going to an out-of-network doctor.
In addition, if your provider charges you more than what your plan(s) considers to be reasonable, customary, or allowed under plan rules, you may have to pay the difference. A licensed insurance agent from EZ can help you understand the out-of-pocket costs associated with each of your plan options.
Weighing Your Options
There are positives and negatives associated with choosing to have a primary and secondary insurance plan. Just as there are with any other type of insurance. Let’s take a look at the pros and cons to help you decide if having two plans might be right for you.
Benefits
Extra Coverage – Having two plans could come in handy in the case of unanticipated medical expenses. And if you find that you frequently have to pay for your own medical expenses out-of-pocket, it may be beneficial to purchase a secondary health insurance policy.
No Gaps – Even if one of your health insurance policies lapses, you won’t experience a gap in coverage if you have a second plan. Your secondary health insurance will just become your primary automatically.
Complementary coverage – Having plans that are complementary, that cover different elements of your healthcare, will mean you’ll get more coverage and better benefits. You’ll be able to make up for what your primary health insurance doesn’t cover with your secondary plan.
Disadvantages
No guarantee – Even if you have two separate health insurance policies, your out-of-pocket costs may still not be covered in full. Keep in mind that the amount of your plans’ coverage cannot be more than the amount of your out-of-pocket expenses.
Extra expenses – Your two separate health insurance policies will still require you to make payments on the associated premiums and deductibles. This may result in additional expenses further down the road.
Overlapping – It’s possible that your coverage from two different health insurance plans will actually overlap if the plans are too similar to one another. Meaning you will not receive as many additional benefits as you might like.
FAQs
What is the birthday rule?
When children are covered by both parents’ health insurance policies, the birthday rule plays a significant role in determining which plan provides primary coverage and which provides secondary coverage. According to the birthday rule, whichever parent’s birthday falls earlier in the year will be the primary insurer. Secondary insurance is provided by the other parent’s plan. The year of birth of each parent does not come into play.
How do I know which is my primary insurance?
You don’t get to choose which plan will be your primary coverage and which will be your secondary coverage. Whenever you file a claim, your primary health plan will cover you as if you didn’t have a secondary plan. After that, your secondary health insurance will cover the rest of the bill. If you have two health plans, there are rules about how your benefits will work together. Some of these rules will be different for you based on your health insurance company and your situation.
Is having 2 plans worth it?
It depends. Having two health plans can save you money if one is free or both are inexpensive. Also, it’s best to make sure they work well together. Check to see if their coverages and benefits overlap or are too similar.
EZ Is Here to Help
Having both primary and secondary coverage can be complicated. It could work for you, but you’ll need to weigh the pros and cons carefully before deciding whether or not to invest in a secondary insurance policy. Feel free to ask EZ anything. Including if having two plans might be right for you, as well as for assistance in locating a secondary health insurance plan, if necessary. We will compare plan benefits and costs for you. And will assist you in locating affordable coverage that meets your needs. Simply enter your ZIP code below to get started with free, customized quotes right now! You can also give us a call at 877-670-3557 to have a qualified insurance professional discuss your needs and help you choose the best policy for you.
For many people, one of the biggest perks of their job is the health benefits. Being offered group health insurance can take a huge weight off of your shoulders. But what if you don’t have enough coverage, are paying too much, or are just not happy with your plan? You can opt for an individual health insurance plan. In fact, an individual plan might be cheaper than an employer-based health plan, and you could end up with more coverage for less money if you use EZ.Insure.
When You Can Change Plans
Most Americans get their health insurance through their employer, but these plans can be limited in their coverage or too expensive. If you want to look elsewhere for your insurance, individual health plans are available through the Marketplace or through private insurance companies. But before switching from your employer’s plan to an individual plan that you should know that:
You can only enroll in a private plan during the Open Enrollment Period from November 1- December 15, unless you qualify for a Special Enrollment Period. You qualify for a SEP if you experience a qualifying life event, such as getting married, adding a family member, getting divorced, or losing employer-based insurance.
Some companies require you to stay on their plan if you agreed to take part; if this is the case, then you are stuck with the plan for the year until your workplace’s Open Enrollment.
If your employer offers coverage that meets “minimum value” standards set by the Affordable Care Act and is deemed “affordable,” you will not qualify for a government subsidy on coverage purchased through your state exchange.
Your Plan Choices
If your employer does not help pay your premiums, or if they do not contribute enough, then it is definitely worth finding your own plan. In addition, if you choose to purchase individual insurance, you will no longer be limited in your choice of plans. If you are unsure which plan might be right for you, EZ.Insure can help you sift through all the available options in your area at no cost to you.
There are a number of different individual plans to choose from; for example, the ACA Marketplace divides its plans into 4 metal tiers. The metal tiers do not indicate the quality of care, but the percentage of care that each plan covers. The more the plan pays, the higher your premium will be.
Bronze – Plan pays 60% of your health care costs, you pay 40%.
Silver – Plan pays 70% of your health care costs, you pay 30%.
Gold – Plan pays 80% of your health care costs, you pay 20%.
Platinum – Plan pays 90% of your health care costs, you pay 10%.
There are also a variety of plan designs to consider:
HMOs– Health maintenance organization plans have restricted provider networks and require referrals to see a specialist.
EPOs– Exclusive provider organization plans require that you stay in-network, but you do not need a referral to see a specialist.
PPOs– Preferred provider organization plans are more flexible and allow you to see doctors in and out of your network, with no referrals required.
EZ.Insure will help you understand all the different types of plans and, because we understand that keeping your doctor is important, we will make sure your doctor is included in your plan’s network.
One of the advantages is the ability to choose a plan that covers your doctor and hospital.
What Individual Plans Cover & Their Advantages
Just like employer-based plans, individual plans cover the 10 essential health benefits, and they cannot charge you more for, or deny you coverage because of, pre-existing conditions. The advantages to an individual plan include:
You can choose the best insurance company and plan to meet your needs.
Your health insurance isn’t tied to your job, so you can change jobs without losing coverage.
You can choose a plan that includes your preferred doctors and hospital.
If eligible, you can get a subsidy from the government.
How EZ Can Help
You do not have to settle for your employer’s health insurance plan if it is limited or too expensive. EZ.Insure wants to make sure that you and your family are completely covered, and we also want to put money back in your wallet! With us you won’t have to worry about spending time searching for a plan that meets all of your needs – we will do all the heavy lifting for you. We will compare all available plans and present them to you, and will help guide you through the process of finding the right one for your needs and budget. We will even help you sign up for a plan at no cost to you.To get instant quotes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.
