Health Insurance Basics - Lesson 3: Dual Coverage

in insurance •  last year  (edited)

Welcome to the third edition in my series about the ins and outs of health insurance.

You can find Health Insurance Basics - Lesson 1: Deductible here: Part 2 addresses "Eligible Medical Expenses," and can be found here:

Today's lesson helps answer the question: Is it worth it to have dual coverage? For example, your employer offers health care benefits, and so does your spouse's company. You have the opportunity to cover each other on your own employer's plan...but does that mean you won't have to pay anything else out of pocket for medical expenses?

Most people are of the impression that if they have a copay with their own health plan, that their spouse's plan will pick up the copay. THIS IS NOT ALWAYS THE CASE! In fact, policies that actually pay the member responsibility as the secondary payer are few and far between.

Most secondary policies will ONLY "kick in" and pay the member responsibility once the Out of Pocket Maximum (OOPM) has been satisfied. That means your spouse's plan won't pay anything for YOUR health care expenses until your bills add up to, let's say $2000 for example.

Depending on how much the spouse's company charges in premium to add a spouse and/or children, it may or may not be worth it to have both policies covering both spouses. If there is a chronic illness or known upcoming surgery, then it may very well be worth it.

My purpose with this post is to let you know that you have to dig deeper and read the fine print. There are no absolutes with health plans. There are MANY variables, and this is a BIG one that could cost you a lot in the end. Sometimes, you are better off just paying your deductible and coinsurance or copay with one policy than paying two premiums and STILL have that member responsibility anyway.

I hope you found this helpful! If you have any questions, feel free to ask!

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I have learnt from this, thank you.
How many family members do company allow their employee to add to the Health insurance?


Usually there is the option to add either a spouse, spouse + children (including step and adopted children), or just children.