Juggling Dual Coverage: Navigating Billing For Two Insurances

It is possible to have coverage under two different health insurance plans, known as double coverage. In this case, the two insurance providers work together to pay the claims of one person, which is called coordination of benefits. There are many reasons why someone might have dual insurance coverage, including being married, being under 26, or being over 65 and still working. When a claim is filed, the primary insurance pays first, and the secondary insurance pays the remaining cost. It's important to note that even after the secondary insurance pays, there may still be out-of-pocket costs.

Primary insurance pays first, up to coverage limits

When a person has two health insurance plans, one is considered the primary insurance and the other is secondary. The primary insurance pays first, up to its coverage limits. The role of primary insurance is determined by the patient's situation and is not chosen by the patient. For example, if a child is covered under each of their parents' separate plans, the primary insurance is determined by the parent's birthday. The primary coverage will be from the parent whose birthday comes first in the calendar year. In the case of an employee with two plans, the employer's plan is usually the primary insurance.

Once the primary insurance has paid what it is responsible for, the secondary insurance pays the remainder of the medical bill, up to 100% of the total cost. It is important to note that even after the secondary insurance pays, there may still be out-of-pocket costs for the patient. The secondary insurance is also determined by the patient's situation and is not chosen by the patient. For example, if a child is covered under their parent's plan and their employer's plan, the employer's plan becomes the primary insurance, and the parent's plan becomes the secondary insurance.

In the case of an adult with two insurance plans, the primary insurance will always pay first. Going out of network will depend on the type of primary coverage. For example, if the primary insurance is a PPO, the patient will have more flexibility to see out-of-network care if needed. However, with an HMO as primary insurance, the patient will not be able to go out of network.

Secondary insurance pays remaining costs

When you have two health insurance plans, the primary insurance is responsible for paying first on any claims. The secondary insurance comes into play if the primary insurance policy is unable to cover the entire claim. The secondary insurance then reviews the claim and what has been paid by the primary insurer, and contributes its portion of the payment based on its benefits and coverage.

The secondary insurance payer covers bills that the primary insurance payer didn't cover. It pays any remaining costs, such as deductibles, copayments, and coinsurances. For example, if Original Medicare is your primary insurance, your secondary insurance may pay for some or all of the 20% coinsurance for Part B-covered services.

In some cases, the secondary payer might not pay all the remaining costs. When this happens, you'll receive a bill for the amount left after the primary and secondary payer's coverage.

You can't choose which insurance provider to use for each visit

Having two health insurance plans can be beneficial in many ways. For instance, if your current insurance plan does not provide sufficient coverage, a second plan can help cover some of your out-of-pocket expenses. Additionally, if one of your insurance policies lapses, you will still have coverage through your second plan, ensuring you don't go without insurance. Furthermore, having two plans can provide greater benefits and more comprehensive coverage, especially if they complement each other.

However, it is important to note that you cannot choose which insurance provider to use for each visit. Once you have established your primary and secondary insurance, your primary insurance will always pay first, and you cannot decide to use your secondary insurance for a particular visit. The primary insurance plan is determined by "coordination of benefits" rules, which are based on your situation. Typically, your employer's plan is designated as the primary insurance, and your spouse's plan or your parent's plan is considered secondary.

If you have two insurance plans, it is crucial to notify both insurance companies about the existence of the other plan for coordination of benefits. While it is not necessary for both companies to agree to this arrangement, they need to be aware of it. When you visit a doctor, you will need to provide the information for both insurance plans. The doctor's office will initially bill your primary insurance, and then send the remaining bill to your secondary insurance.

It is also important to remember that having two insurance plans does not mean you will be reimbursed twice for the same visit. The combined benefits from both plans will not exceed 100% of the total cost of your visit. Additionally, you will still be responsible for paying two premiums and possibly two deductibles, which can result in higher expenses. Therefore, it is essential to carefully consider your specific situation and weigh the pros and cons before deciding to get a second insurance plan.

You'll need to pay two premiums and might have two deductibles

If you have two health insurance plans, you will need to pay two premiums and may have two deductibles. This means that you will need to pay two sets of fees for your insurance coverage, which can increase your overall costs.

The primary insurance will pay first, up to its coverage limits, and the secondary insurance will pay the remaining cost, which could be part or all of the remaining medical bill. It is important to note that even after the secondary insurance pays, there may still be out-of-pocket costs that you are responsible for.

The determination of which insurance is primary and which is secondary depends on your situation. For example, if you are a child covered under each of your parents' separate plans, your primary insurance is determined by their birthdays. The primary coverage for the child will be from the parent whose birthday comes first in the calendar year.

When you have two insurance plans, it is important to notify both insurance companies. They will need to be aware of the coordination of benefits, which outlines how the claims will be paid by each insurer. This coordination ensures that the total amount paid by both insurers does not exceed 100% of the total cost.

Having two insurance plans can provide benefits, such as increased coverage and potential savings. However, it is important to consider the additional costs of premiums and deductibles, as well as the potential for increased paperwork and communication with two different insurance providers.

You'll need to notify both insurance companies for coordination of benefits

If you have two health insurance plans, you will need to notify both insurance companies for coordination of benefits. This is because, when an insurance claim is filed, the primary insurance plan will pay first, up to its coverage limits. The secondary insurance plan will then pay the remainder of the medical bill. In some cases, there may still be out-of-pocket costs for the patient after the secondary insurance has paid out.

The primary insurance plan is determined by the patient's situation and is set by coordination of benefits rules. For example, if you are covered by your spouse's insurance and your employer's insurance, your employer's plan is usually primary, and your spouse's plan is secondary. If you are under 26 and covered by both of your parents' plans, the birthday rule usually applies—the parent whose birthday comes first in the calendar year provides the primary insurance.

When you have two health insurance plans, you will need to give both your primary and secondary insurance information to your doctor. It is important to note that you cannot choose which insurance provider to use for each doctor's visit. Your primary insurance will always pay first.

Frequently asked questions