Dual Coverage

Hi everyone,

I currently have an Anthem Blue Cross PPO plan through my employer, with my wife added to my plan. She just got hired and now can purchase health insurance through her work place. She has insurance through Aspire Health and will be adding me to her plan. I have my open enrollment coming up soon and need to decide whether or should drop my plan (and her along with it) and just be on hers, or keep the plan and have us both have dual coverage by having a secondary insurance through the other’s insurance as a dependent. My dilemma is this:

My plan covers 80% in network, 60% out if network, and has a $500 deductible.

Her plan is a 3 tiered system. Tier 1 at a particular group of doctors/hospitals/clinics are 100% covered with no deductible. Tier 2 is 80% coverage for a larger range of providers. Tier 3 is everything else and covers 60%. Her insurance basically feels like a better version of mine since it almost has a “super in network) where everything is covered.

My current PCP will soon be out of network for my current insurance, meaning my insurance will only pay 60%. Does anyone know how the math works when insurance billing takes place for the following type of dual coverage situation? Would it be something like this?:

I visit a hospital that is out of network for my primary insurance but Tier 1 under my secondary insurance. For easy math, let’s say the hospital bill is for $1000. I pay $500 for my deductible, and for the remaining $500, my primary insurance pays $300 (60%), leaving me a bill of $200. Then my secondary insurance, which is from my wife’s job, kicks in and pays the final $200 since they cover this 100%. Is this correct?

And if I were to go back to the same hospital after my primary insurance’s deductible has been met, it should now result in me paying nothing since anything that is left would be covered by my secondary insurance, correct?

Thanks in advance, as I know it was a lot to read.