Comparing Health Plans from Different Employers

More than half of U.S. households are dual income, where both spouses are employed. Many of those households are also eligible for health coverage from two separate employers. While having an abundance of health coverage options is great, it also presents couples with several challenging questions:

• Should they maintain two separate health plans, or opt for only one?
• If picking one plan, what factors should be considered?
• What’s the best way to compare plans between different employers?  

In this article, we’ll provide you with some tips for making these decisions. We’ll discuss the pros and cons of having two plans instead of one. We’ll also look at how to do a side-by-side plan comparison to help you make the right choice for your family.

Two or One?

Should both spouses be on the same health plan, or should they have separate plans? That’s one of the first questions couples face when deciding how to structure their health coverage.

About 70 percent of couples go the one-plan route, while about 30 percent stick with separate plans, according to a survey by Morning Consult and CNBC.

On the surface, it may make sense to be on one plan, so there’s only one monthly premium to pay instead of two. But you should look more closely at the details of adding a spouse to a health plan before making your decision.

Some employers won’t allow a spouse to be enrolled, if that person is eligible for coverage from their own employer. Other employers that do allow spouses to join an employee’s plan impose a surcharge, which could be as much or more than the premium the spouse would pay at their own employer. So, you should consider whether going with one plan will actually save you money on premiums. If you have children, review what the cost would be to add them to the health plan as well.

You’ll also want to review how the benefits in your spouse’s plan stack up against your own employer’s plan (we provide more information on how to do that below). If the coverage for medical services you frequently use is not as good on your spouse’s plan as your own employer’s, it may be beneficial to remain on your employer’s plan.

Dual Coverage

There are situations where being on both your employer’s plan and your spouse’s plan may make sense. For example, it can be beneficial to have a primary and secondary health plan if you have a lot of medical expenses. Once your primary plan has processed a claim, if there are any unpaid costs, they can be submitted to the secondary plan for payment.

A secondary plan may fill in coverage gaps that the primary plan leaves open. You’ll need to consider whether the extra coverage is worth paying two premiums, along with meeting two annual deductibles. Keep in mind that you may still have out-of-pocket costs, such as copayments and coinsurance, even with two health plans.

A drawback of having two health plans (aside from having two premiums and deductibles to pay) is that the claims payment process could take longer and be more complex with two insurance companies involved.

Plan Comparison

Let’s say you’ve made the decision to go with just one health plan to cover both spouses and your dependents. Your next task will be doing a comparison to see which employer’s plan best meets your household’s needs.

If your employer offers a choice of health plans, select one that you are interested in and try to find the closest match among plans the other employer is offering. That will make it a more accurate comparison. The employers may have organized their plans by metals groups – gold, silver, bronze, etc. – to make it easier to find similar plans.

Each plan should have a summary of benefits that lists what the plan covers. Look at plan features such as copayments, coinsurance, deductibles, and out-of-pocket maximums. If it’s not an exact match, that’s fine – you just want to be looking at the most similar plans that the two employers offer.

Once you’ve selected plans to review, creating a simple table like this one will make your side-by-side comparison easier. Enter what your costs would be for using various medical services, including copayments and coinsurance. Be sure to add lines for services that are important to you or that you expect to use.

Topic	Employer A	Employer B
Monthly premium (with spouse and dependents added to plan)
Overall deductible
Out of pocket limit
Primary care visits
Specialist visits
Diagnostic testing
Prescription drugs
Outpatient surgery
Emergency room care
Urgent care
Inpatient hospital stays
Mental health services

After you’ve filled in the table, estimate your total annual costs for each plan, including premiums, deductibles, copayments, and coinsurance. You can look at your claims history for the last year or two (available in the Member Resource Center) to get an idea of how often you use different medical services. You can also base the estimate on expected use, if you have some medical care coming up, such as surgery or a pregnancy.

Your comparison should consider more than just costs. Check whether your doctors, preferred hospitals, and other service providers are in the health plans’ networks. Also look at whether there is coverage for using telemedicine and out-of-network providers, if you want to visit doctors or facilities that are not in-network.

Here are some other things to consider:

• What services are excluded from coverage?
• Does the health plan require a referral to see a specialist?
• Are dental and vision benefits included in the benefits package? If so, how do those compare? Be sure to check if add-on benefits are available through other vendors like VSP Vision Care or Delta Dental.
• Does the employer offer to reimburse health expenses through a health reimbursement arrangement (HRA)?
• Are flexible spending accounts (FSAs) or health savings accounts (HSAs) offered?

When you’ve reached your decision, be sure to inform both employers by the open enrollment deadline. You may want to check with the employer where coverage was declined to see if they offer an opt-out incentive or cash-in-lieu of benefits. If this is available, it can be used to help you pay the premium at the other employer.

Choosing a health plan is an important decision, so take your time to thoroughly review the options and don’t hesitate to ask questions. You can contact the employer’s human resources department for more information. If you are considering one of our Qualified Health Plans (QHP), please give our Consumer and Business Support Services team a call at (800) 255-4550 or email consumersupport@bcbsvt.com.