Taking your plan and your spouse’s may not double your fun

I have a choice between my health plan from my job, or my spouse’s plan from his job.  My plan is far inferior to his.  If I take my plan and his plan, the inferior plan becomes the primary plan for me.  Would that reduce my whole coverage?  And what happens if I go to a doctor that doesn’t accept my plan, but does accept his?

Betwixt and Between

Dear Betwixt and Between,

Unless your plan or your spouse’s plan is free, it rarely makes sense to have two plans in place.  You are correct that your employer’s plan would be primary, and then your spouse’s plan.  If you went to a provider that accepts your spouse’s plan, the claim would still go first to your plan where it would be rejected.  Then your spouse’s plan would get the claim and pay it according to its plan.  They would also get the primary plan’s denial reason.You should check your spouse’s plan’s Coordination Of Benefits rules.  It’s possible that they will pay second on claims that were denied by the primary plan.  It’s also possible that they will not pay these, on the theory that you should only get as much as the primary plan allows.

Even if your spouse’s plan will fill in all of the gaps of your own employer’s plan, you should think long and hard about keeping both.  It will complicate every bill that is filed for you.  You will always get a denial letter from one plan when the other plan has paid something on your behalf.  The hassle may not be worth the very little extra benefit that you might (or might not) get.

You should also make sure that your spouse’s plan will cover you, if you have another employer’s plan offered to you.  Some companies are pruning their lists and taking off anyone who could get his health insurance from his own job.
Linda Riddell

About Linda Riddell

A published author and health policy analyst with 25 years’ experience, Linda Riddell's goal is to alleviate the widespread ailment of not knowing what your health plan can do for you.