Question about health insurance – Married and we each have a plan…

posted 5 months ago in Finances
Post # 2
Member
4437 posts
Honey bee

This is how mine works as well. We are both on each others insurance as the secondary. My insurance “pays” first, and then my husbands pays anything left over. We just give both cards to the dentist (or whoever) and they figure it out. 

No idea about pregnancy though. 

Post # 3
Member
1296 posts
Bumble bee
  • Wedding: May 2018

My work is the same way! My insurance is half the cost of FI’s but spouses are not allowed on it if their work offers insurance.

It would overall cost us more for me to move to his insurance after marrying. We will just stay on our own but I will move to his during the year we are TTC (since I plan on quiting my job to be a SAHM).

Post # 4
Member
1255 posts
Bumble bee

Hi Bee,

I have two plans and am currently pregnant.  I have a commercial insurance through my job and then I also have a governmetn plan because I had left my job in December and registered through the healthcare marketplace and, since I had no income, they qualified me for medicaid.  I was pissed at the moment but it actually works out to my benefit now that I’m pregnant.  My primary insurance through work has a $1400.00 deductible and 80/20 coinsurance so, even after my deductible is satisfied, I’m still responsible for 20% of the “allowable cost” of any service I have.  This means that the insurance will make their contracted adjustment to the overall cahrge from the doctor and I am responsible for 20%.

The claim gets automatically forwarded to my secondary insurance, which processes the remaining cost.  Since my secondary plan has no deductible or coinsurance/copays, I’m left with no balance.  However, if your secondary plan does have a deductible and coinsurance/copay, it would process the claim using those benefits. I’ll provide an example.  Let’s say you go to the doctor and your visit is $1000.00.  Primary insurance gets it and applies that entire $1000.00 to your deductible.  Then secondary insurance gets it.  If your deductible is hypothetically only $100.00 with the secondary insurance, then they pay $900.00 and your doctor will send you a bill for $100.00.

As long as you know that your husband’s insurance will act as a secondary policy, I think that you would be very smart to take out the most minimal coverage you can to save money.

Post # 5
Member
1255 posts
Bumble bee

I realize that this may not be the most in-depth example but I’ve been on the administrative side of healthcare and insurance for a decade now so, if you have any other questions, I’m sure I’d be able to answer them.

Post # 6
Member
1878 posts
Buzzing bee
  • Wedding: Chateau Lake Louise

MrsGirlyGirl :  So the situation you describe is pretty typical. For example, I work for a large healthcare system and have excellent benefits at a very low cost. My FH has not-so-great benefits at a fairly substantial cost.

My company has a policy that you can insure your spouse, but if they have other benefits available they do not use, there’s a $75 a month “cost offset” fee you have to pay in addition to their premiums; that is unless the cost of their employer offered policy has a deductible in excess of $5000 

It may be the case that there is a similar exemption for your husband’s coverage. He should definitely speak with HR before you make any decisions.

That being said, if you DO keep your own policy and end up using his coverage as secondary, make sure you choose a low-deductible version of your own coverage, as secondary policies will not cover deductibles for primary insurance. If there’s a high out of pocket (co-insurance) rate, those costs are typically covered. So, when choosing a plan, try to find one with low deductible, but higher coinsurance to maximize the benefit of your secondary insurance. 

Good luck!

Post # 7
Member
8827 posts
Buzzing Beekeeper
  • Wedding: October 2013

when Darling Husband and I first got married, we each kept our own plans.

but when we had a child, he declined insurance at his job and we moved to the family plan at my job. 

 

Post # 9
Member
343 posts
Helper bee

MrsGirlyGirl :  No one has mentioned it yet… make sure your cheap policy is not an HMO. With HMO, you have a more limited doctor choice.

Post # 11
Member
1255 posts
Bumble bee

marriedbeeexpecting :  I had an HMO for years and it caused me no trouble at all.  Usually, the coverage is great and, if it’s a big name company like Cigna, Aetna, UHC, or BCBS, ALL the doctors take it and your “limitations” aren’t really a thing.

Post # 12
Member
672 posts
Busy bee

I literally had never heard that an employer can refuse coverage (or primary coverage anyway) of a spouse if they have insurance from their own job. Good thing to know in case I run into that one day. Does that still apply if the spouse has a plan offered from her work but she has never taken it as it’s a bad plan and completely unaffordable? Or is it that if she’s already covered somewhere they won’t let you drop it for their primary? 

Post # 14
Member
5542 posts
Bee Keeper

summertime8 :   MrsGirlyGirl :  my friend’s company has this policy – they will not cover a spouse if they have access to a plan through their own employer. My old company didn’t have that policy, but since they covered 100% of the employee premium and 0% of the spouse’s premium no one took the family plans. 

Post # 15
Member
343 posts
Helper bee

PrincessPeach13 :  Haha, several degrees later and this is my field but yep I am totally wrong and didn’t double check this at all before posting.

Leave a comment


Find Amazing Vendors