Secondary Insurance: Everything You Need to Know

Secondary Insurance: Everything You Need to Know
Secondary Insurance

A medical plan may include secondary insurance or it may be purchased separately. When your primary medical plan does not cover certain operations and treatments, it helps to fill the gap.

Certain supplemental insurance plans may provide you a cash benefit. If you experience a serious illness or injury, these policies might help you pay for your out-of-pocket medical expenses.

What is secondary insurance?

A person who is covered by two health plans is said to have secondary insurance; one plan will be recognized as the primary health insurance plan, and the other will be the secondary insurance. Health claims are initially filed with the primary insurance. The secondary insurance will then cover any expenses that are still covered by its health plan.

Coordination of benefits refers to the collaboration of two health insurance companies to offer coverage. Insurance companies can prevent double payments for claims in this way. This doesn't imply that you receive twice as much money or reimbursements, but if one plan has better coverage for a service than the other plan, it could aid in defraying the cost of your medical care.

Supplemental insurance, such vision, dental, or accident coverage, is also sometimes referred to as secondary insurance. For additional information on supplemental insurance, see the definition in our glossary.

How does secondary insurance work?

Any coverage gaps for expenses, services, or both are filled by your primary and secondary medical insurance plans working together.

  • Insurance for treatments and services that aren't commonly covered by your medical insurance may be available through complementary health plans, such as those for cancer, vision, and dental care. Usually, a part of secondary insurance plans are deductibles, copays, and coinsurance. Your insurance policy starts to partially pay your bills once you have met the deductible. When you see a provider, you might have to make a little payment, known as a copay.
  • If you become ill or injured and your insurance covers it, a lump-sum insurance plan pays you a cash benefit. Typically, you are permitted to use the funds however you like. In addition to paying off medical debt and your deductible, you can use it to cover basic expenses like childcare, groceries, rent, and utilities.
  • Gap insurance products help you with out-of-pocket medical bills. For example, you may use a gap insurance plan to help pay the deductible for your medical plan, dental plan, or vision plan. It can also help cover your copays and any coinsurance payments that you make.
  • Certain add-on insurance plans may need you to pay a monthly premium. The type of plan and degree of coverage you choose will affect the premium cost.
  • There are numerous secondary insurance policies that you can choose from. They can give advantages for varied pricing and styles of care if you require care.

What makes primary health insurance apart from secondary health insurance?

Health insurance is one item you may have extras of. One may be covered by both employer-based insurance and supplementary insurance, such as coverage under a spouse's plan. Children may also be covered by the health insurance of both parents. One of your health insurance plans is primary, and the other is secondary if you have two.

Primary health insurance is the policy that goes into effect first and covers claims as if it were the only source of medical treatment. The secondary insurance plan picks up some or all of the tab for the remaining expenses after the primary insurance plan has covered the claim.

The primary plan cannot be selected by an individual; instead, the insurance firms involved coordinate the benefits, a process known as coordination of benefits.

Who is eligible for second insurance?

Although there are no prerequisites for eligibility, there are three situations where secondary insurance is most common:

  • Children under age 18 whose parents both have health insurance: Children can be added to either parent's health insurance plan. The insurance plan that belongs to the parent whose birthday occurs first in a given year is typically referred to as the primary insurance plan, while the insurance plan that belongs to the parent whose birthday occurs later is referred to as the secondary insurance plan. The birthday rule is another name for this.
  • Under-26-year-old adults with health insurance: Unmarried and married children can continue to be covered by their parent's insurance until they turn 26 thanks to the Affordable Care Act (ACA). These people may also be covered by a health insurance program offered by their job or school. Their parents' plan will serve as their secondary insurance, with their employer's or school's plan serving as their primary insurance.
  • Adults who are married or living together and who both have health insurance: The spouse or partner will have both primary insurance (their own plan) and secondary insurance (their spouse's plan) if both people in a marriage or domestic relationship have health insurance. They can add their spouse or partner to their plan as a dependent.

What kind of insurance fall under the secondary group?

Secondary health insurance, volunteer insurance, or additional insurance can refer to a wide range of different sources of protection, including:

  • Vision
  • Dental
  • Disability insurance
  • Life insurance
  • Accident insurance
  • Hospital Care Insurance
  • Cancer Insurance
  • Medicare Supplement Insurance (Secondary insurance for Medicare)

What does secondary health insurance not cover?

Depending on your plan, secondary insurance typically won't cover procedures or treatments that are unproven or done purely for aesthetic reasons. Every supplementary health insurance plan you are contemplating should have fine print that you should read. Normally, there are coverage and service limitations. Visit to find out more.

Where can you buy supplemental health insurance?

Independent insurance companies supply this coverage. Plans, coverage, and conditions come in a wide range of variations.

  • If you purchase a medical plan independently via the Health Insurance Marketplace, you can obtain supplemental or backup coverage from a private insurance company.
  • You might be allowed to sign up for one or more secondary or supplemental insurance if your employer provides your medical care. In such a case, you can still get one on your own from a private insurance company.

Final word

It's important to keep in mind that the Affordable Care Act's (ACA) requirements do not apply to the majority of secondary insurance. For instance, insurance companies have the authority to ask you about your medical history and, in some cases, to refuse to provide coverage. Ensure you comprehend the conditions of any additional coverage you acquire, including exclusions and limits.