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Having More Than One Health Plan

Robin Gelburd, JD, is the president of FAIR Health, a national, independent, nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 28 billion claim records contributed by payers and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. CMS as a national Qualified Entity, FAIR Health also receives data representing the experience of all individuals enrolled in traditional Medicare Parts A, B and D; FAIR Health houses data on Medicare Advantage enrollees in its private claims data repository. Gelburd is a nationally recognized expert on healthcare policy, data and transparency.
Having Two Health Plans: The Pros and Cons
Having two (or more) health plans can be a good choice if the savings you receive outweigh the costs. For example, if you have to pay the full premium to maintain each plan, and the premiums are high, the costs might outweigh the savings. But, many employers pay part of the premium, and your share may be low. In that case, being covered by two employer-sponsored plans (for example, yours and your spouse’s) may be cost-effective.

The savings come because the two plans’ cost-sharing rules may differ. Those are the rules about what portion you must pay of your healthcare costs. Suppose your primary plan covers 50% of the cost for a certain procedure that costs $100. Then, your out-of-pocket cost for that procedure would be $50—if that were the only plan you had. But, suppose your secondary plan covers 80% of the cost of that procedure. After your primary plan pays its 50%, your secondary plan pays the other 50%. The secondary plan keeps to its rule about paying no more than 80%. It also keeps to the rule about not paying the doctor more than 100% of the bill. And, you save $50.

Notice that, in this example, if you only had the secondary plan, you would have had to pay $20 (20% of the $100 bill). That would be better than paying $50. But paying nothing is better still.

Another potential savings arises from the fact that plans often cover different services. Your primary plan may not cover acupuncture, but your secondary plan might. Your primary plan may not cover an expensive specialty drug, but your secondary plan might. By having two plans, you increase the odds that the service or medication you need will be covered.

There are drawbacks to consider, too. The secondary plan may not pay all the costs left uncovered by your primary plan. And, you may have more paperwork and headaches dealing with two plans rather than 1. You’ll have to notify each insurer about the other. When you go to the doctor, you’ll have to give both your primary and secondary insurance information. Since each claim must be processed twice, claims may take a long time to process.

The choice is yours. Do what you think is best for you and your family.

Your Action Plan: when considering whether to have more than 1 health plan:
  • Read the plans’ documents carefully to see if you might save money by having them both. Look especially at the cost-sharing provisions.
  • Make sure you understand which plan would be primary and which would be secondary.
  • Call the member service representatives of both plans if you have any questions about how the claims process would work.
  • Consider how much you’ll have to pay in premiums for more than 1 plan.
  • Consider whether you would want the hassle of having more than 1 plan.
  • Remember there is not 1 right answer.


Robin Gelburd, JD, is the president of FAIR Health, a national, independent, nonprofit organization with the mission of bringing transparency to healthcare costs and health insurance information. FAIR Health just launched a new consumer website for New Yorkers, YouCanPlanForThis.org, and relaunched its award-winning national consumer site, fairhealthconsumer.org. FAIR Health possesses the nation’s largest collection of private healthcare claims data, which includes over 24 billion claim records contributed by payors and administrators who insure or process claims for private insurance plans covering more than 150 million individuals. FAIR Health also holds separate data representing the experience of more than 55 million individuals enrolled in Medicare. Certified by the Centers for Medicare & Medicaid Services (CMS) as a Qualified Entity, FAIR Health receives all of Medicare Parts A, B and D claims data for use in nationwide transparency efforts.


 

 
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