Having Two Healthcare Insurance Policies: What You Need to Know

In a recent post, a user asked about having two health insurance policies. They had a grandfathered plan from 2009 and recently became an employee for a state agency that includes a BCBS policy as a benefit. They wanted to know how co-insurance works and what happens with deductibles and copays.

How Co-Insurance Works

Co-insurance is a type of cost-sharing in which the insured person pays a percentage of the cost of covered medical services after the deductible has been met. The other percentage is paid by the health insurance company.

For example, if you have a co-insurance rate of 20%, you will be responsible for paying 20% of the cost of covered medical services after you have met your deductible. The health insurance company will pay the remaining 80%.

Co-insurance applies to both hospital stays and medications once the primary policy deductible has been met.

How Deductibles and Copays Work

A deductible is the amount of money you must pay out-of-pocket before your health insurance starts paying for covered medical services. A copay is a fixed amount that you pay for covered medical services, such as a doctor’s visit or prescription drug.

Deductibles and copays apply to both primary and secondary insurance policies.

How Coordination of Benefits Works

If you have two health insurance policies, the insurance companies will coordinate benefits to determine which policy is primary and which is secondary. The primary policy will pay first, and the secondary policy will pay the remaining balance, up to the maximum allowed by the policy.

In most cases, the primary policy is the one that is provided by your employer. However, there are some exceptions to this rule. For example, if you have a grandfathered plan, it may be considered the primary policy even if you have a policy through your employer.

What to Do If You Have Two Health Insurance Policies

If you have two health insurance policies, you should contact both insurance companies to find out how they will coordinate benefits. You should also review your policies carefully to understand your coverage and the co-insurance, deductibles, and copays that apply.

Seeking Licensed Agent Help

If you are confused about how health insurance works or how two policies will interact, it is always a good idea to seek professional help from licensed insurance agent. A licensed agent can help you review your policies and answer any questions you have about your benefits.