The Differences Between Primary, Supplemental, and Secondary Health Insurance

Primary, Supplemental, and Secondary Health Insurance

What are the differences between primary, supplemental, and secondary health insurance? You may already know this, but you are entitled to have health insurance coverage under more than one plan. In fact, you are entitled to have a healthcare plan with more than one insurance company. When you have more than one plan, you will have primary insurance and secondary or supplementary insurance.

Your various insurance plans do not work together to provide you with double the benefits. Rather, the insurance companies have a developed system called coordination of benefits. This arrangement provides a method for determining which company pays the different expenses you may incur through doctor and hospital visits. While your primary health insurance is the first to receive a medical claim, you may not have coverage for all lab work and treatments. This is when your secondary or supplemental insurance will help to pay for the rest of the costs.

It can be confusing to distinguish between each type of insurance plan and how they work in coordination with one another. This article intends to explain these differences.

Types of Insurance

Primary Health Insurance: If you have more than one healthcare plan, one plan will be designated as the primary. Usually, this is the insurance coverage that you have through your employer. Even if your spouse has more comprehensive insurance through their employer, yours will still be designated as your primary health coverage. The primary is the insurance that pays its portion of your medical claim first.

Secondary Health Insurance: Your secondary healthcare plan is the insurance that pays the rest of your medical claim. The claim is submitted first to your primary and that plan pays out the maximum amount you are allowed. Then, your secondary helps to cover the rest. For example, if you have a $6,000 surgery to remove your appendix and your primary will only cover 80% (or $4,800), your secondary insurance will help to cover the remaining $1,200.

Supplemental Health Insurance: Supplemental health insurance is slightly different than primary or secondary plans. It still works in coordination with your benefits, but is purchased on your own as extra insurance. Often, people purchase a supplemental policy to cover aspects of healthcare that were left out of your primary plan, like dental and vision care.

Generally, this type of coverage helps to pay for the deductibles, copayments, and/or coinsurance of a medical claim. Just like secondary insurance, it does not replace your primary insurance or double your benefits. Rather, it supplements those out-of-pocket costs you may incur.

Advantages

One of the greatest advantages to having more than one plan is extended coverage. For example, if you submit a medical claim to your primary care insurance and only a portion of it was covered, you can then submit the claim to your secondary insurance.  Your primary may not cover certain tests at the hospital or doctor’s office that your secondary might cover. This coordination of benefits will relieve you of having to pay for these treatments and tests out of pocket.

Disadvantages

There are costs involved in adding more healthcare coverage. Supplemental plans are paid for out of pocket. A plan may be as low as $12 per month for an individual or $30 for a family. However, it is an added cost that you need to consider. In order to determine if a supplemental plan is right for your budget, think of a medical scenario and then add up all of the costs involved. Add up your deductible and any other expenses you might incur after a medical event which involves a long stay in the hospital. Then figure out how much your supplemental insurance might help with those costs and the overall costs of keeping this additional healthcare plan.

If coverage for your primary and secondary plans are nearly identical, then you are paying twice to have the same benefits. Especially if both plans have deductibles, then your out-of-pocket costs for having more than one plan may not be worth it.

Different Scenarios

Children: If you have children, the “Birthday Rule” determines which parent’s plan will be considered their primary and secondary plans. The plan covering the parent whose birthday arrives sooner in the calendar year will be the child’s primary coverage. They will then be listed as dependents under your plan.

Young Adults: The Affordable Care Act permits young adults to stay on their parents’ healthcare plan up to the age of 26. Even if you are married, you can still be on your parent’s plan. However, once you are offered insurance through your employer, then you need to choose between the two. You cannot use your employer’s plan as your primary and your parents’ plan as your secondary (or vice versa).

Example: Medicare

Medicare is the best way to explore the differences between primary, secondary, and supplemental healthcare insurance plans.

Medicare is the government assisted health care plan for those over 65 years of age, those under 65 who have certain disabilities, and those with permanent kidney failure. It becomes your primary health insurance after you turn 65. It is designed to take care of short-term medical conditions and does not cover long-term care.

If you are 65 years of age or older, qualify for Medicare, but are still working, then there is a rule for determining which plan will be the primary and secondary. If you work for a company that has less than 20 employees, then your employer’s group healthcare insurance plan will be the secondary and Medicare will be your primary. If the company has more than 20 employees, then that coverage will be the primary.

Once you qualify for Medicare and are retired, you may still have coverage through your former employer. If you do, this is called retiree coverage. Retiree coverage serves a similar purpose as a Medigap plan. It fills in holes in your Medicare coverage, such as deductibles and coinsurance. In addition, your retiree insurance may include added benefits, like longer hospital stays after surgery.

If you have a health concern, most likely you will run across certain instances in which your Medicare, retiree, or other insurance plan fails to cover your medical visits and procedures completely. Medigap can be a helpful supplement. It is a plan offered by private insurance companies to help pay for these extra costs. And you don’t need to cancel your original Medicare plan to have Medigap.

A variety of costs may be covered through a Medigap policy, including:

  •      Additional days in the hospital
  •      Medical care while traveling internationally
  •      Deductibles
  •      Co-payments

Since the federal government has standardized Medigap, different insurance companies that sell the plans offer the same exact benefits. There are a variety of options, but Medigap Plan F is purchased most often. It is the most comprehensive supplemental plan available, and the beneficiary has no out-of-pocket expenses for doctor and hospital visits. As this plan covers the most deductibles, coinsurance, and copayments, it is also the most expensive.

Speak to an Agent

To find out more, speak to an independent insurance agent with an expertise in healthcare coverage. They will have the knowledge and experience to recommend the best coverage to suit your needs.

It’s up to you to determine much healthcare coverage you want. As stated by Mark Colwell of GoHealth.com, “Insurance is a risk management product. You have to figure out your comfort level from a risk management perspective.

Other Enhanced Insurance articles related to Healthcare:

Health Insurance (Includes Video)

Affordable Care Act

Insurance Exchange — I Don’t Get It

How Much Does Health Insurance Cost

The Evolution of Health Insurance

How Do I Choose Health Insurance

Affordable Health Insurance

Average Health Insurance Cost

Factors That Influence Health Insurance Premiums

Health Insurance Broker

How to Choose Health Insurance

Travel Health Insurance

Why Didn’t the Federal Government Have a Bond on Healthcare.gov?

Adding Your Baby to Your Health Insurance

Business Accident and Health Insurance

Enhanced Insurance is not written by attorneys. If you’re looking for legal advice, you need to contact a lawyer. Further, insurance practices and forms change constantly and are varied from state to state. For definitive answers in your area, contact a local agent.

While the majority of people want an agent involved in their purchase of insurance, many people want to see if they can save money by buying direct from the insurance company. Others want to try a direct quote to make sure the premium they’re now paying through their local agent is fair. If you want a quote for your coverage, click on the competitive quote button on the right side of this page.

Jenna Christianson has a passion for research and writing. She has worked as a researcher for a variety of organizations ranging from genealogy to the transportation industry and everything in between. She is excited to be a part of the Enhanced Insurance team!

9 comments on “The Differences Between Primary, Supplemental, and Secondary Health Insurance

  1. Hi Jenna
    I will be 65 next April so I am doing my research on medicare. I was told that in regards to medicare insurance that there is a difference between supplement insurance ad supplemental insurance. I found the information on the medigap supplement insurance helpful. So is there a difference or are the words interchangeable or are both insurances even offered? Thank you for your time and insights.
    Cheryl R.

  2. My husband and I are “trapped between 2 insurance agencies. ” Each company has determined that the other company is “primary” & neither will pay first. We get billed from providers. HELP!

    • One of the biggest problems with Obamacare has been the way they excluded agents from the process.About eighty percent of the insurance buying public wants an agent involved in the process. Those companies that have tried to write insurance direct have found little, if any, savings in cutting out agents. Just like any other human endeavor there are bad agents and good agents. A good agent is with her weight in gold. I have five decades of experience and I still have an agent.

  3. Im 28 yrs old and is gona go through gastric bypass in a couple days but my employer insurance dont cover all of it. I also have 3 months prior expenses from the procedures that are needed to be paid. I was wanting to look for a secondary insurance to cover the rest so i dont have to pay out of pocket? Which is my best option to get?

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