When should both spouses get benefits from their jobs?

Question

My wife and I get medical, dental, and vision benefits through her job. Generally we've been pretty satisfied with them. Now for the first time, my job is offering health, dental, and vision as well.

The providers through my job are all different than those through hers. Were I to sign up, I suppose I would have to go through the hassle of changing doctors, transferring medical records, etc.

That issue aside, is there any advantage to having benefits through both providers?

EDIT: Here are some specifics. We live in the United States.

My wife's coverage is entirely paid by her employer. It's an "integrated" HMO plan: their doctors, labs, and pharmacies take only their own insurance. (It's very convenient.)

My employer is offering both a PPO and an HMO (not the same as our current one). I would have to pay monthly, and the amount is significant. I would have to change doctors because the "integrated" plan can't be use elsewhere.

RESOLUTION: I decided to decline the coverage from my employer. I would have to pay, I couldn't keep using my current health network, and any advantages you mentioned seemed not to apply to me. Thanks for all your advice.

Answer 1

In the United States in some cases if both spouses have access to health insurance the employers expect that the other spouse will get it from their employer.

If both spouses have access to health coverage the two companies/insurers will want to know about the other coverage so that benefits can be coordinated. This is so there isn't double reimbursement for an expense.

Generally a family wants to consolidate coverage under one company to ease the paperwork burden. But there could be cases where it might be cheaper to split the family between two policies. I would imagine it might occur if the spouses were living in separate locations and both networks are available where one spouse lives. It also might make sense if one person needed coverage for a specific procedure and only one policy covered it. Before the changes eliminating non-coverage for preexisting conditions, you could have had one spouse remaining on their plan to make sure they received the coverage they need.

Answer 2

I just recently went through this myself. I am currently covered under my wife's family plan, and I recently took a job that also offers health insurance. Our health insurance plan just came up for renewal and it was time to decide how to proceed. The two biggest considerations in my case were:

1. My wife's employer charges an additional premium of $45 per pay period ($1170 per year) if I can get insurance from my employer and decline it.
2. Since we have a child and another on the way, the premium and family deductible would be the same whether I am on the policy or not. So the exact cost of me being on the policy is $1170 per year as described in point #1.

For us the decision was easy since my premium with my company would be more than $100/month, and then I would also have a new separate deductible to hit.

Side note: I considered for about 3 seconds of simply lying and not checking the box that I am declining insurance from my employer so I could save the additional $1170 per year. But in the 4th second I decided against breaking the law.

Answer 3

When you have insurance from two sources like this, they "co-ordinate coverage". That is, the two insurance companies talk to each other whenever you have a claim to make sure that they are not paying out more than the amount of the claim. Like if both policies say they'll pay 80% of your medical expenses, sorry, they won't pay a combined 160% so you can make a profit by getting sick. They'll max at 100% between them.

Whether it's worth it to have both policies depends on the terms of each. In the best case, between the two they'll cover 100% of medical expenses. But more likely not, usually other terms in the policy prevent this from happening.

I haven't done a study on this, but I suspect that in most cases, the extra premiums you would pay to have two policies would be way more than any likely benefits you would receive. If both policies are 100% company paid or if you only have to contribute a small amount to the premiums, it might be worth it. But if you have to pay any significant share of the premiums, probably not. I say this because if you're medical bills are relatively small -- if you're both healthy and maybe you have a check-up or some minor issue once or twice a year -- you won't meet the deductible for either policy, the insurance will pay zero or some very small amount, and you'll have paid the extra premiums for nothing. If your bills are large -- either or both of you have major chronic medical problems -- then you'll hit the out of pocket maximum beyond which either insurance company will pay 100%, and the second policy adds nothing. So there's only even a possibility of it paying off if your medical bills fall in the middle somewhere.

BTW getting different insurance does not necessarily mean you will have to get a different doctor. There's a lot of overlap in the networks. I've gone through four insurance companies in the last five years (because of all the monkey wrenches that Obamacare threw into the system) and I've kept the same opthamologist throughout (I have glaucoma), he was in the network for all of these companies.