Do you and your spouse and children all have different health plans? Or are some of you covered by more than one plan? This can definitely be challenging for managing your finances—different deductibles, authorization rules, co-insurance and co-pays. Here’s what every family with multiple coverage should think about:
Know the provider networks
It will likely simplify your life to find providers who are covered under both plans. This doesn’t have to mean everyone sees the same doctor. Rather, look for larger medical groups or hospitals. This will usually allow you to choose physicians who practice in the same group or at least the same office, which could make logistics and billing easier. One word of caution: doctors who belong to the same medical group may not all accept the same insurance—so go by the plan and the doctor’s word, not by the location of the office!
Bring it online
Tools like Simplee.com pull you and your dependent’s health insurance claims together in one place, allowing you to sort and organize bills, see how much of a deductible has been paid, and quickly find information about each plan’s benefits.
Understand coordination of benefits
This is probably the most important thing to know if one person in your family has coverage from more than one plan. It’s not too common outside of Medicare, since most of the time, this means paying for more than you need. But if you do have two sources of coverage, you’ll need to know who is the primary payer and who is the secondary. Inform both of your plans about the other and ask how they coordinate. Then be sure to provide your doctors with both insurance cards and tell them which is primary so that the plans are billed correctly.
Determine if you really need different plans
It is often cheaper to get everybody on one plan, but this is not always the case. When it comes to premiums, families with more than one child can usually get a good deal, since some “family plans” offer the same price for one dependent as they do for two or three. Yet, under some circumstances, adding a spouse to a plan can be substantially more expensive than each spouse getting coverage on their own.
For deductibles, you’ll need to find out whether there is a separate deductible for each member, or a combined family deductible. Some plans may have more complicated rules where two or three members must meet their individual deductibles before the plan covers services for anyone. Beware of these types of plans, because your family could end up spending a lot and still not meeting the requirements to get the plan to start paying. In general, combined deductibles tend to save you the most money.
But costs aside, it’s essential to consider the medical needs of every family member. For someone with a pre-existing condition, there may be a waiting period of several months before a new plan will cover the condition, depending on when they last had coverage and were treated for the condition. And, of course, plans have different levels of coverage, so a very comprehensive plan might be better for an intense medical condition, but unnecessary for a family member who rarely visits the doctor.
Here is the most important rule for comparing and choosing plans: consider all the costs involved – premiums, deductibles, co-pays, out-of-pocket maximums. Too many people shop only by the premium because that’s the first number they see (and the easiest to wrap your head around). Don’t fall into this easy trap.