How Do You Determine Which Health Insurance Is Primary?

Fran
Fran Majidi
October 2, 2020

Some people have more than one insurance coverage. If you have a spouse, you can be on their insurance plan and your own. If you have children, you may both buy health insurance for that child. This doesn’t mean that your doctor gets paid twice when you go for a visit. And it doesn’t mean that you can claim the visit with one insurer while the other pays for the visit (that would be fraud). What it does mean is that you have a primary and a secondary insurance plan. You will want to coordinate payments so that your bills are as close to 100% covered as possible.

How Do I Coordinate Benefits?

You’ll want both of your health insurance plans to pay and for you to pay as little as possible, maybe even nothing at all. The way coordination of benefits works is that when you have a health insurance claim, it should go first to the primary plan. That insurer will pay what it owes. If there’s a remainder, then that bill goes to the second insurer, which pays what it owes. You’ll then be responsible for what’s left over, if anything.

So, let’s say you have a bill for $500 from a visit. If your primary insurer pays $300 and your secondary insurer pays $150, you will owe $50.

When you visit the doctor and register as a new patient, you’ll most likely be given a form to fill out about your insurer(s). Here, you’re responsible to give the accurate information about both health plans so that the medical billings department can bill your insurers accurately.

If you only had one insurance plan when you began seeing a specific doctor and now have two plans, it’s important for you to share this information with the billings department. Otherwise, they will bill you according to the initial information you gave them.

Who Can Have More Than One Insurance?

Anyone can have more than one insurance plan but the most common people are parents who both add a child to their individual plans. Other people who have more than one health insurance plan are married couples, who often have individual plans through work and are also added to a spouse’s plan. Also, people under the age of 26 sometimes remain on their parents plans but buy an employer’s plan too.

When Is a Health Plan the Primary Insurance?

In the instance where parents both insure a child, the birthday rule applies, and whichever parent has the earlier birthday holds the primary plan. If the parents are divorced, the parent with custody would carry the primary insurance and the other parent the secondary one. If they have joint custody, the birthday rule applies again.

8 Things to Watch Out for if You Have Secondary Insurance

1. You’ll have to pay two premiums.

2. You may have two deductibles.

3. You’ll have two different health insurance companies to juggle.

4. You may have two different types of plans (HMO and PPO for example) and it can get confusing.

5. You’ll have to remember which is primary.

6. It’ll be more difficult to dispute if you end up paying more than you expected.

7. It’ll be challenging to be with in-network providers for both plans.

8. Remember which plan covers what can be a daunting task.

Find Affordable Health Insurance

Advantages to Having 2 Health Insurance Plans

It costs little to be added to a parent’s or spouse’s employer health plan since some employer health plans offer family coverage at a flat rate. And if they are already offering insurance to another family member, adding you may come at no cost at all. This is a big benefit to families with more than one child under the age of 26. The second adult child gets added to a parent’s health plan free of charge.

For private health plans, ask your provider for how much it would cost to add an adult child onto the plan. Is it a good deal? Here’s another advantage. Because you have health insurance coverage through a parent’s plan or a partner’s plan, you don’t have to worry about going uninsured if you lose your job or change jobs.

Choosing a Plan

Most people opt for an HMO or PPO. If you are single and you are looking to keep healthcare costs down, an HMO plan may be right for you. Are you happy using only in-network providers for your healthcare services? And are you fine with a primary care physician coordinating your care? If so, a cost-effective HMO plan may be right for you. Does your family have a lot of different specialists that they like to see both in and out of network? The flexibility of a PPO plan may be right for you. Even if you are single if the providers you want are mostly out of network, it is better to choose a PPO plan. It gives you the options you are looking for in a health plan. If you’re confused, begin with entering your zip code here, and you’ll fill out a brief form before getting in touch with the right agent.

Compare and Save

Are you searching for one or two health insurance policies? SmartFinancial is a digital insurance comparison engine that provides real-time rates and insurance services in all 50 states. You’ll only need to complete a quick form and we’ll provide you with quotes from local insurance agents in your area. You can compare coverage and rates from multiple vendors in your area. Find the best prices on superior health insurance the intelligent and easy way by entering your zip code below.

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