I am currently on my partner’s health insurance along with our two kids. We picked an HDHP plan because we see several out-of-network providers regularly, so we end up reaching our deductible fairly quickly and the premiums are very low. I’ve done all the math and this was the best choice.
Now I’m about to start a new job where I am offered a company health insurance plan with no premium for me alone to join it, and I’m wondering if it makes sense for me be on both plans with a coordination of benefits situation. The most important thing for us is that my health expenses continue to count toward our family plan’s deductible. We really want all of our health expenses lumped together working toward that deductible. So here’s what I need to understand:
Say I see my regular out-of-network provider who bills me $300 a visit. If I go on my new employer’s insurance, that will be my primary insurance. The bill goes to them, where the out-of-network deductible is $5500. The $300 is counted toward the deductible and I am reimbursed nothing. Then, my understanding is that I can pass the bill along to my secondary insurance (our family plan). If I do that, what I want to happen is that the $300 will count toward our family out-of-network deductible of $5000. I still am reimbursed nothing, but we are $300 closer to meeting our family deductible.
Is that what will happen? It seems like double-dipping in a way because the same visit would count toward two deductibles. We live in Maine if that matters.
Related questions: I am used to filing out-of-network claims myself. Is that process going to be much more complicated if I’m dealing with coordination of benefits? Also, the coverage I’m being offered through my new employer isn’t really all that great. Even though it’s not an HDHP plan, it has higher deductibles than our HDHP plan, and higher coinsurance rates. The prescription coverage seems worse/more complicated. The only benefit to it that I can see is that office visits are a $45 copay, whereas on the HDHP plan there is no coverage at all of office visits (except preventative) until you meet your deductible. Now, my assumption is that the secondary plan would kick in and make up the difference where the primary plan is lacking. And of course, the primary plan would be totally free to me. But maybe it’s too much hassle/uncertainty for a marginal benefit.
submitted by /u/landorock64
[link] [comments]I am currently on my partner’s health insurance along with our two kids. We picked an HDHP plan because we see several out-of-network providers regularly, so we end up reaching our deductible fairly quickly and the premiums are very low. I’ve done all the math and this was the best choice. Now I’m about to start a new job where I am offered a company health insurance plan with no premium for me alone to join it, and I’m wondering if it makes sense for me be on both plans with a coordination of benefits situation. The most important thing for us is that my health expenses continue to count toward our family plan’s deductible. We really want all of our health expenses lumped together working toward that deductible. So here’s what I need to understand: Say I see my regular out-of-network provider who bills me $300 a visit. If I go on my new employer’s insurance, that will be my primary insurance. The bill goes to them, where the out-of-network deductible is $5500. The $300 is counted toward the deductible and I am reimbursed nothing. Then, my understanding is that I can pass the bill along to my secondary insurance (our family plan). If I do that, what I want to happen is that the $300 will count toward our family out-of-network deductible of $5000. I still am reimbursed nothing, but we are $300 closer to meeting our family deductible. Is that what will happen? It seems like double-dipping in a way because the same visit would count toward two deductibles. We live in Maine if that matters. Related questions: I am used to filing out-of-network claims myself. Is that process going to be much more complicated if I’m dealing with coordination of benefits? Also, the coverage I’m being offered through my new employer isn’t really all that great. Even though it’s not an HDHP plan, it has higher deductibles than our HDHP plan, and higher coinsurance rates. The prescription coverage seems worse/more complicated. The only benefit to it that I can see is that office visits are a $45 copay, whereas on the HDHP plan there is no coverage at all of office visits (except preventative) until you meet your deductible. Now, my assumption is that the secondary plan would kick in and make up the difference where the primary plan is lacking. And of course, the primary plan would be totally free to me. But maybe it’s too much hassle/uncertainty for a marginal benefit. submitted by /u/landorock64 [link] [comments]Read Morer/HealthInsurance