Ask The Expert: Health Insurance Options
February, 2021

I am covered by my spouse’s HMO health insurance. I have serious health problems and I am wondering, if I can go on my employer’s health plan that has a different network. Can I use that plan for specialty care and my spouse’s plan for routine care?

Expert Answer:
Excellent questions since it is very important to navigate insurance carriers to make the best of your coverages. Unfortunately, the way insurance works – you will not be able to pick and choose – your insurance from your employer, since you will be the subscriber, will be primary and your spouses will be secondary coverage. After your insurance covers your medical expenses, if your spouse’s insurance is richer than your own, it would provide additional coverage. For the children, the subscriber whose birthday comes first in a calendar year is primary coverage and that insurance runs charges through first before the secondary coverage (from the parent with the later birth date) will kick in and pick up any additional available coverage.

If your employer’s offering is a PPO it will be a richer plan than an HMO and will give you flexibility to see doctor’s in and out of network so sometimes that becomes a decision-maker on whether or not to add your plan. I would recommend you evaluate both existing plan and the plan offered by your employer thoroughly before making the choice.

Now the problem might be getting into your employer’s plan since you won’t be eligible to enroll unless during an open enrollment period or you might have eligibility because you started a new job with a new employer.