In today’s complex healthcare landscape, many individuals are considering the option of having multiple health insurance plans to maximize their coverage and minimize out-of-pocket expenses. While this approach can offer significant benefits, such as broader access to healthcare providers and enhanced financial protection, it also comes with its own set of challenges. Understanding the pros and cons of this strategy is crucial for making informed decisions about your healthcare needs.
A financial advisor can help you create a financial plan to help you save for healthcare costs in retirement.
Reasons to Have Multiple Health Insurance Plans
Having multiple health insurance plans can significantly enhance your coverage options. By combining plans, you can access a broader range of healthcare services and providers. This is particularly beneficial if one plan offers better coverage for specific treatments or medications that the other does not. Here are four common reasons you might have coverage from multiple plans:
- Americans aged 65 and older receive Medicare coverage from the federal government. They can supplement this insurance with a private plan (such as an employer’s health insurance) or Medicaid if they qualify.
- Spouses can cover each other through an employer’s insurance. For instance, say you have health coverage through your work, and your spouse is a dependent on your plan. If your spouse finds a job with health benefits, you can keep them on your insurance while they receive coverage from their new employer.
- U.S. law allows people under the age of 26 to receive coverage from their parent’s plan. So, if you can keep coverage from a parent’s plan while getting your own from an employer or the marketplace.
- The law for children under the age of 26 also applies to divorced parents. As a result, each divorced parent can name their child as a dependent on their health insurance.
How Does Having Multiple Health Insurance Plans Work
Having multiple insurance plans means one plan will be your primary coverage, and the other will be secondary. As the names imply, your primary coverage activates first, and your secondary coverage picks up any unaddressed expenses if necessary. Your Coordination of Benefits (COB) defines which health plan takes precedence in these situations.
Every health care plan has a COB policy that governs how it interacts with other health coverage. This way, the insurance companies communicate with each other to avoid reimbursing a patient twice for the care they receive. The COB ensures you receive a maximum of 100% of the cost for a procedure or doctor visit.
For example, say you break a bone and need surgery and physical therapy. Your COB will help you receive reimbursement for up to 100% of your healthcare costs and prevent double reimbursement. Because overlap usually exists between multiple plans, COB is necessary to keep patients from taking advantage of duplicate reimbursements.
Remember, having multiple plans doesn’t guarantee that your healthcare will be free. Despite the surplus insurance coverage, you typically will still pay copays, coinsurance and other out-of-pocket costs. For example, most plans charge a copay to see a specialist, so multiple policies won’t nullify this requirement.
Primary and Secondary Health Insurance Rules
State laws and insurance policies determine which of your plans becomes the primary and secondary. While the unfortunate reality is that you can’t choose this for yourself, gaining awareness of how the rules work can help you take advantage of your insurance plans. Here’s how each scenario impacts your primary and secondary plans:
| Scenario | Primary Insurance Designation | Secondary Insurance Designation |
|---|---|---|
| Your employer-sponsored plan plus your spouse’s or partner’s plan | Your employer-sponsored plan | Your spouse or partner’s plan |
| Medicaid plus employer-sponsored plan | Employer plan | Medicaid |
| Medicare plus employer-sponsored plan | Employer if the workplace employs 20 or more people. Fewer than 20 employees means Medicare is primary. | Medicare if your workplace employs 20 or more people. Fewer than 20 employees means the employer’s plan is secondary. |
| Under age 26 with insurance from a student or employer plan plus your parent’s dependent coverage | Your student or employer’s plan | Parent’s plan |
| Children receiving coverage from both parents’ plans (divorced or separated) | The parent with the earlier birthday in the calendar year | The parent with the later birthday in the calendar year |
| Children receiving coverage from both parent’s plans (divorced or separated) | The parent with custody provides primary coverage. Joint custody means following the birthday rule described above. | If the parent with custody remarries, the new spouse’s plan becomes secondary coverage. Otherwise, the parent without custody is secondary. |
Pros and Cons of Having Multiple Health Insurance Plans
Having two health plans might sound like a benefit with no costs. However, there are points to consider on either side, as no strategies are going to be the perfect fit for everyone. Here are three common pros:
- More savings: Multiple plans can offset more costs, increasing your savings when receiving healthcare. For example, your primary insurance might only cover 80% of a specific procedure. If your secondary insurance covers the rest, you bear no cost.
- Continuous coverage: Job loss and turning age 26 can result in the loss of coverage. Fortunately, your secondary insurance can prevent a lapse in coverage even if you lose your primary plan.
- More accessible care: Most health insurance plans limit the types of procedures and care providers you can access. Multiple plans expand your access, allowing you to see doctors outside your primary plan’s network and receive reimbursement for different forms of care.
Here are three common cons:
- Lack of savings: Although multiple health insurance plans can improve your coverage, they don’t guarantee payment-free services or a 100% cost reduction. As a result, you can still incur heavy expenses for various types of care. In addition, multiple health plans never result in you receiving surplus payments from insurance companies.
- Double the fixed costs: Two health insurance plans mean paying two premiums and deductibles. This situation means a greater monthly premium cost and a higher out-of-pocket cost to satisfy each plan’s deductible limit.
- Redundancy: Multiple forms of coverage can overlap too much to be worth it. In other words, if your plans don’t expand your healthcare options, you may not experience a huge advantage.
Having multiple health insurance plans should be part of your greater financial planning, which you. may want to talk over with your financial advisor.
How to Find a Health Insurance Plan
There are several ways to find a health insurance plan. First, federal law requires employers to offer health benefits to full-time employees. So, finding a full-time job (working at least 30 hours a week) is a direct ticket to a health insurance plan.
On the other hand, working part-time means you must handle health insurance yourself. You can compare plans on healthcare.gov or use an online broker to break down plans for you. Remember, federal law prevents price differentiation between companies, so each type of plan will cost the same among providers. As a result, choosing a company with high customer service ratings should be a priority.
Your age and financial circumstances can also help you determine which healthcare plan makes sense. For example, turning 65 means you qualify for Medicare. Enrolling when you turn 65 is crucial because you’ll incur financial penalties for applying late (exceptions exist, such as those receiving healthcare from their job). In addition, state Medicaid programs provide low-income families and disabled individuals with low- or no-cost health insurance.
Do I Need Two Health Insurance Plans?
Whether you need two health insurance plans depends on your individual circumstances, preferences, and healthcare needs. Here are situations where having two health insurance plans makes sense:
- COBRA transition: If you lose your job or transition to a part-time position, you can receive health insurance from your employer for up to 18 months due to the Consolidated Omnibus Budget Reconciliation Act (COBRA). You can also purchase an individual plan during this transition to ensure continuous coverage when COBRA expires.
- Specialized coverage: You have a specific medical condition or need (such as fertility treatments or cancer therapies) that is better covered by a separate, specialized insurance plan.
- Coordination of benefits: You and your spouse both have employer-sponsored health insurance plans. Having both plans allows you to coordinate benefits and reduce out-of-pocket costs for medical expenses.
- Medicare supplement during retirement: Medicare doesn’t cover every form of healthcare. For example, original Medicare doesn’t cover eye exams or dental care. Therefore, you purchase supplemental coverage (such as Medicare Advantage) to cover the costs.
With those in mind, here are two common scenarios when it doesn’t make sense to have two plans:
- Overlapping coverage: Both plans provide similar coverage, and the benefits largely overlap. The services covered by both plans are redundant, and you are not likely to use the additional services provided by the second plan. As a result, having two plans in such cases results in unnecessary premium expenses.
- Limited benefits: One of the plans provides comprehensive coverage, and the second plan has limited benefits that do not significantly enhance your overall healthcare coverage.
If you aren’t sure what the right strategy is to maximize your ability to hit your long-term goals, consider working with a financial advisor.
Bottom Line
Having multiple health insurance plans can offer both advantages and disadvantages that are important to consider. Ultimately, the decision to hold multiple health insurance plans should be based on individual healthcare needs, financial considerations and the ability to manage the intricacies involved. By weighing these factors, you can make informed choices that best suit your circumstances.
Tips for Having Multiple Health Insurance Plans
- Health insurance is a part of every monthly budget because of premium costs. Fortunately, a financial advisor can help you create a financial plan that accounts for healthcare costs. Finding a financial advisor doesn’t have to be hard. SmartAsset’s free tool matches you with vetted financial advisors who serve your area, and you can have a free introductory call with your advisor matches to decide which one you feel is right for you. If you’re ready to find an advisor who can help you achieve your financial goals, get started now.
- Retiring means entering a new phase of accessing healthcare and using health insurance. Because health insurance during retirement can be challenging to navigate, it’s essential to brush up on your options and make an educated decision.
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