If both spouses have health insurance which is primary?

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In general, when both spouses have insurance plans, your own plan is your primary insurance plan and your spouse’s plan is your secondary insurance plan. If you’re in a situation where both health insurance plans will be used, the insurers coordinate how bills are paid with each other through the “Coordination of Benefits” (COB).

COB is a widely practiced industry standard that insurance companies use to determine which plan will pay first and what the second plan will pay. 

With the benefits of COB and dual health insurance plans, you can save more on out-of-pocket expenses. But at the same time, the added premium payment and deductible might increase your overall health expenses and cause further financial complications.  

Because of this, it’s important to understand the usefulness of having dual healthcare coverage and make an informed decision accordingly. 

Dual health insurance coverage for married couples

When both spouses have health insurance, they have dual health insurance. It is important to understand which policy is primary and which is secondary in order to file a claim. Read primary vs. secondary coverage for more information.

Insurance companies seek aid from the coordination of benefits (COB) to determine which plan will pay first and how much the second plan will pay. However, coordination of benefits can be complicated, especially if you have one type of plan, such as an indemnity plan, and your spouse has an HMO. 

How COB works under dual health insurance

First, the primary plan pays your claims according to the provisions of your policy. If there is a second policy, it will pay for what the primary plan didn’t, but only as long as the medical treatment or services are covered benefits under that plan. 

For example, if your visit to the doctor costs $60 and your primary plan pays $40 of that, your secondary plan would pay the remaining $20 (if the visit is covered). The plans will not pay more than 100 percent of the cost of treatment, nor will they pay for treatment that isn’t covered.

Lastly, dual coverage can be expensive, so be certain that it makes financial sense to pay for both. You don’t want to pay more than you’ll ever get back in benefits by having dual coverage. 

How do you determine whose insurance is primary? 

In determining which plan is primary and which is secondary, a plan without a COB provision is generally considered primary. When both plans have COB rules, the plan you are enrolled in as an employee or as the main policyholder is your primary health insurance. The plan in which you are enrolled as a dependent — on your spouse’s plan, for example — is secondary.

Contact your insurer or read your policy to determine how your dual coverage works.

Prachi Singh

Contributing Researcher

 

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Prachi is an insurance writer with a master’s degree in business administration. Through her writing, she hopes to help readers make smart and informed decisions about their finances. She loves to travel and write poetry.

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