What happens when patients are covered by two medical insurance policies?
Asked by: Broderick Bergstrom | Last update: December 4, 2025Score: 4.4/5 (30 votes)
Do you still pay a copay if you have two insurances?
In most cases their secondary policy will pick up the copay left from the primary insurance. There are some cases where the secondary policy also has a copay and those patients may end up with a copay applied after both insurances process the claim.
When a patient has dual coverage, the primary insurance is?
Final answer:
The primary insurance plan for a patient with dual coverage is typically the one where they are the policyholder, with the dependent coverage acting as the secondary payer.
Can a person have two health insurance policies?
Yes, you can have two health insurance plans and it is perfectly legal, but it is also important to fully understand how primary vs secondary insurance operates.
How do you determine which insurance is primary and which is secondary?
The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn't cover.
Wife and I Disagree About Health Insurance
Does secondary insurance cover what primary does not?
It depends on which insurance is considered “primary” and which is “secondary.” The insurance that pays first (primary payer) pays up to the limits of its coverage. The insurance that pays second (secondary payer) only pays if there are costs the primary insurance didn't cover.
What is the coordination of benefits rule?
“Coordination of benefits” or “COB” means a provision establishing an order in which plans pay their claims, and permitting secondary plans to reduce their benefits so that the combined benefits of all plans do not exceed total allowable expenses.
Can I have a high deductible health plan and a secondary insurance?
Other coverage that is allowed in addition to an HDHP
The IRS does allow you to have some types of coverage in addition to your HDHP, without jeopardizing your eligibility to contribute money to your HSA.
What is double insurance?
Double insurance refers to the method of getting insurance of same subject matter with more than one insurer or with same insurer under different policies. This means that one can get insurance policies on a subject matter more than its value. Double insurance is possible in all types of insurance contracts.
Are providers required to bill secondary insurance?
They either pay the coinsurance or they leave it as patient responsibility. When it comes to obligation, it's a courtesy to file secondary if the provider is not credentialed/contracted but in the case were the provider is contracted with the insurance then he/she is contractually obligated to file the insurance.
What happens if a patient is covered by two different policies?
Having two health plans doesn't mean you'll receive full medical coverage twice. Instead, one policy will be your primary plan, and the other will be your secondary health coverage. This ensures the total amount your two plans will pay for your health expenses will never exceed 100% of the cost of those expenses.
How is primary and secondary insurance billed?
Primary insurance pays first for your medical bills. Secondary insurance pays after your primary insurance. Usually, secondary insurance pays some or all of the costs left after the primary insurer has paid (e.g., deductibles, copayments, coinsurances).
What does dual coverage mean?
In a dual coverage scenario, the primary carrier (or primary plan) will pay a larger portion of the benefits, while the secondary carrier (or secondary plan) pays a smaller amount.
How do deductibles work with two health insurances?
If both plans have deductibles, you'll have to pay both before coverage kicks in. You don't get to choose which health plan is primary, meaning the one that pays first. You don't get to choose which insurer will pay a certain claim.
Which health insurance company denies the most claims?
According to the analysis, AvMed and UnitedHealthcare tied for the highest denial rate, with both companies denying about a third of in-network claims for plans sold on the Marketplace in 2023, respectively.
Can a patient have both copay and coinsurance?
For some services, you may have both a copay and coinsurance. Our plan does not have a copay. The most you will have to pay for covered medical expenses in a plan year through deductible and coinsurance before your insurance plan begins to pay 100 percent of covered medical expenses.
Is double coverage illegal?
The short answer to that question is yes, you can have two health insurance plans. In fact, it's becoming increasingly common for individuals to have more than one health insurance plan.
What are the effects of double insurance?
Overlapping coverage: Both plans provide similar coverage, and the benefits largely overlap. The services covered by both plans are redundant, and you are not likely to use the additional services provided by the second plan. As a result, having two plans in such cases results in unnecessary premium expenses.
What is the doctrine of double insurance?
The doctrine arises when an insured is entitled to an indemnity from two different insurers in respect of the same liability. The rationale is that payment by one insurer benefits the other and the equitable principle of indemnity requires that the burden be shared.
Who should avoid a high deductible health plan?
While these types of plans can be beneficial to those who are relatively healthy, they can be very expensive for those who have chronic conditions or who experience a medical crisis. It's important to carefully consider your expected medical expenses before choosing to participate in a high deductible health care plan.
What happens if you have primary and secondary health insurance?
Primary health insurance is the plan that kicks in first, paying the claim as if it were the only source of health coverage. Then the secondary insurance plan picks up some or all of the cost left over after the primary plan has paid the claim.
Can I have both HSA and PPO at the same time?
Yes—you can use an HSA with a PPO.
How do you determine which insurance is primary?
Primary insurance — Primary insurance is a health insurance plan that covers a person as an employee, subscriber, or member. Primary insurance is billed first when you receive health care. For example, health insurance you receive through your employer is typically your primary insurance.
What is the birthday rule?
The rule requires that the parent whose birthday comes first in the calendar year would cover the cost of delivering the new baby regardless of whether one parent has better health coverage for a newborn than the other.
Can you have two health insurances with Medicaid?
The simple answer to the question of “can you have both Medicaid and private insurance?” is a resounding “YES”! Medicaid is given to low-income U.S citizens in need and will not be disputed due to already enrolled in a private health insurance program.