What's the best strategy to combine 2 health insurance policies?

Question

I currently have a 80/20 PPO with an annual $250 deductible. $10 dr visits, $5 to 12 for drugs etc through my job. . . my fiance has an HMO plan w/ his job. After we're married, I thought it would be good to have both an HMO and a PPO plan (we both have to have a health insurance plan through our jobs), but someone told me it's better to have 2 PPO plans and combine. If so, why? Or should we go one PPO, and a HDHP (high deductible plan) instead? Since both our jobs make us pay the same for our insurance whether we're single or have a family, we'd like to add one another on each other's plan but what is the best strategy to pay the least for good insurance?

Answer 1

    I have 25 years experience working with insurance from both the patient side-I have 15 chronic illnesses- and the medical billing clerk side.  I recommend that you go with 2 PPO's.  This way you are both covered should one of you become unable to work, you will still be covered under the spouses plan.  HMO's do not allow you to go to the specialist you need without first seeing your primary care doctor, so you are having to pay a co pay twice, whereas a PPO doesn't have that requirement, so in the long run you are saving on medical expenses.

Answer 2

You don't want two policies.  You want one good one.  Many companies won't allow you to have two policies anyway since it is an administrative nightmare.

Answer 3

Do you really "have to have a health insurance plan through our jobs"?

You don't need two policies. Choose the one that is the best value, and put both of you on it.  The only possible advantage of being covered by both plans is if they have different networks, and then is only an advantage if you used a provider out of your network.  The risk is probably not worth the extra premiums.

Having a HDHP is a great idea, but won't allow you open up an HSA if you are covered by another plan with copays.  

Don

http://mtnhealthinsurance.com

Answer 4

You have to consider the premium cost of both, the out of pocket expenses of both (based on the estimated number of times you go to the doctor in a year and what type of services you normally use).

The HMO might cost less in premiums and co-pays, but you have to consider the doctors that you use. Are they in the HMO network?

If choice of doctor is important to you, the PPO might be a better choice-but it will cost more. Premiums are higher and out of pockets expenses are higher (deductibles and co-insurance amounts.)

No matter how you go at it, you are not going to get 100% coverage by combining the two coverages. It simply doesn't work that way. Most times, a secondary will only pick up a balance UP TO what they would have paid if primary.

Your best option is not to have dual policies and apply the premium cost of what you would have paid toward the out of pocket expenses of the plan you eventually decide on.

If at some point in time, one or the other loses his/her job, that is a qualifying event enabling that spouse to be added to the still working spouses insurance. so you do not have to worry about not having insurance because one loses it.

Answer 5

Who the heck is the "someone" you're taking advice from?  You'll have to ask them the "why".  It never works out the way they're probably thinking,  unless one of the plans is welfare insurance (which WILL pick up copays and deductibles).

A policy through YOUR employer is always going to be primary for you.  A policy through your husband's employer is always going to be primary for him.  You can't pick and choose which company to file the claim with.

I seriously, seriously doubt the insurace is going to cost YOU the same, for individual vs. family plan.  

You are NOT going to get "no out of pocket" coverage with these two plans.  You're MUCH more likely to get "they have to pay it" and fingerpointing, with NO insurance company paying, and you spending massive hours on the phone trying to get SOMEONE to pay it.