So our situation is this: we have a young daughter with serious long term health issues that require a lot of ongoing treatment from various different specialists. I have healthcare through my job, for a big multinational tech company, and we pay through the nose for the “Cadillac” plan through United. We are fairly happy with that considering. I mean its US healthcare, so its still a Kafkaesque nightmare of denials and bureaucracy that is basically a second job to deal with, but they seem to pay for more (with less copays, coinsurance, etc.) than other plans I’ve dealt with.
Now my wife is going back to work, and has landed a role at a startup that offers health insurance. So what is gained (or lost) if we list my wife’s new plan as “secondary insurance” (we don’t have details but based on experience will likely be significantly worse plan than the one I have, given its from an early stage startup) Whenever we’ve asked about secondary insurance in the past people started talking about medicaid, etc. rather than another private insurance plan.
So is there a chance a secondary insurance plan, even if its a much worse type of plan, could cover something our expensive primary insurance won’t? And is there a downside to listing it, like can our primary United provider go “Oh normally we’ll cover that 100%, we’ve decided your secondary insurance should do that, and they only cover 5% so you’ll need to pay the difference”. I mean I’ve not heard of that, but it seems like something that would happen in the US healthcare system
You can choose one of the plans as a primary insurer and any additional costs beyond the primary insurance benefits will be paid by the secondary insurer. It usually works out quite well. A common problem is that you have to file with the secondary for uncovered charges yourself while the health care provider files with the primary insurer directly. I think that still beats paying out of your own pocket. Any deductibles will have to be covered by you, they can’t be billed to a secondary plan.
But how does that work if the secondary plans has much lower coverage (which I imagine is the case in this case). So like if our primary plan covers something 75% and the secondary plan covers only 20%, will the secondary plan cover anything at all? or just 20% of the remaining 25%, or something else?
So a worst case (we flake about claiming on the secondary insurance) would be the same as having no secondary insurance, not any worse off?
In my experience, it’s the latter. The secondary would cover 75% of the 25% that the primary didn’t pay, minus any secondary unpaid deductible. I don’t see a real downside, but I assume your wife would be paying a premium for her secondary insurance so you need to factor that in.
I would create a spreadsheet and perhaps use last year’s medical costs to see if you would have come out ahead if your wife had worked, you had to pay her deductible, and paid all the monthly premiums.
You would have to check the details of the policies to see how they deal with percentages. There is no way you can end up worse off in coverage but as @dolphinboy says you have to see if the extra coverage is worth what you have to pay for it, while keeping in mind that In tough circumstances extra coverage could save you enormous amounts of money.
YMMV, but I have generally not had good luck with multiple health insurance coverages. Specifically, when I was in college, I was covered by the school’s insurance (which was paid for by my NROTC scholarship), as well as being on my father’s family plan, as well as being on my stepfather’s TRICARE (military) insurance.
When I was injured once and went to the ER, all three insurance companies pointed at the other others to pay first. The school insurance and my father’s insurance company decided my TRICARE coverage was primary, and they would not pay anything until TRICARE paid. But by law, TRICARE always pays last. So it was a catch-22, and nobody paid. I ended getting taken to collections for unpaid bills despite having three health insurance coverages.
For about 2 years I had two medical insurances. It worked out great. The healthcare providers did all the filing of claims and such. I didn’t have to do anything.
Many times the policies overlapped a bit and I’d get a check in the mail with some legal explanation as to why the overpayments went to me and not back to the insurance companies. This was between the years 1994-1996.
I didn’t have to contribute to either plan so I made out like a bandit.
Some years ago company insurance policies were that if the spouse had insurance, then the employee’s insurance was primary for him and the spouse was secondary.
Some years back my wife and I both had medical coverage through or jobs. Different insurance companies. Her company’s policy was that the employee’s insurance was primary and the spouse’s was secondary. My company tried to claim that they did it alphabetically, My 1st name started with a L hers with a B: therefore my company’s insurance was secondary. Neither was going to pay my bill until the other paid. It took a trip to personal and threating them with calling the union about being denied a benefit that was in the contract. So my employer’s insurance accepted being primary on me and secondary on my wife.
I’m a health insurance claims adjuster, so while coordination of benefits isn’t my specific job (I deal with accumulations overages and discrepancies and RX accumulators), I’m familiar with it. A few points.
You do not get to pick which policy is primary. Medicare, Medicaid, Tricare, and some special plans like student, short term, and travel policies have their own special rules, but for two regular commercial policies, carriers have agreed on the NAIC (National Association of Insurance Companies) rules. In your case, a kid covered by both parents, the one that matters is #2, the “Birthday Rule”, the plan of the parent who’s month and day of birth falls earlier in the year is primary.
The net result after both claims process depends on the COB type of the secondary policy. Back 20 years ago there were some more generous types that might pay some or all of your cost sharing left from the primary, but now the most common type is called “Carve-Out” or “Hard Non-Duplicative”, which basically ignores cost sharing from the primary, with the net result is you’re responsible for the lesser of the two cost sharing amounts.
Generally the hassle of having two plans is only worth it if the secondary policy is free, or close to free and has lower cost sharing, or the secondary policy covers something the primary does not that you need, whether it’s a particular provider, a particular drug, or a particular service (assisted reproduction and noncomplicated maternity for dependents being common ones that not all policies cover).
So just an update here. I can confirm the getting secondary insurance was an absolutely bloody terrible idea.
We opted for getting the insurance (after the agent insisted it would be secondary and would not effect her or my daughters primary insurance). While it didn’t effect my daughters or my insurance, it was listed as primary for my wife, so all her medical care was denied (including OB/GYN care for her pregnancy, even though her OB/GYN didn’t actually take the new insurance) .
And then not only that, they laid her off (while my daughter was in the ICU which was a whole thing ) but didn’t remove her from the plan! So for a full year after she left the company our primary insurance (United) was refusing to pay out, as she had “primary insurance” elsewhere, and rather than just be able to say “No, fuck off, I don’t have that insurance (or that job) any more”, there was months of paperwork to get it sorted, including having to approach the company that laid her off, because of course there was (as the US constitution sez its not healthcare unless involves months of paperwork and hours of fraught calls to at least two huge multinational companies). By time time it was sorted her providers were about report the debt to collection agency (I wouldn’t be surprised if some of it was actually sent to an agency and ends up on our credit report).
So yeah that’s what happened. Goes to show you should always assume the worst of the US healthcare system, and you’ll still probably be disappointed.
As an aside, since Canadians are fully covered by government insurance, most larger companies offer benefits that fill in the missing peices. I have prescription coverage, dental, vision care, and additional services - massage therapy, chiropractic, orthotics and similar. My wife also has a plan from work, and her plan, like mine, covers spouse. So when I get a prescription, my plan covers the cost except for the copay, and hers covers the copay since it’s less than what it would cover of the full price. Same, her plan dos not cover chiro, but she uses mine to the max of $350/yr, then submits the rest to a catch-all Health Spending Account that’s part of her plan. Same with dental. Primary coverage is your own plan, and the spouse plan will pay what it will cover beyond that. Some things, like her orthotics, we have to pay and submit bills; but dental and prescription direct-bill the insurance companies.
There are dedicated gap filler plans in the US (most Medicare recipients have one), but a second employer plan definitely doesn’t do that and may in fact make things worse.
) but didn’t remove her from the plan! So for a full year after she left the company our primary insurance (United) was refusing to pay out, as she had “primary insurance” elsewhere, and rather than just be able to say “No, fuck off, I don’t have that insurance (or that job) any more”, there was months of paperwork to get it sorted, including having to approach the company that laid her off, because of course there was (as the US constitution sez its not healthcare unless involves months of paperwork and hours of fraught calls to at least two huge multinational companies). By time time it was sorted her providers were about report the debt to collection agency (I wouldn’t be surprised if some of it was actually sent to an agency and ends up on our credit report).