Secondary insurance

What is secondary insurance?

Secondary insurance coverage is when someone is covered under two health plans—one plan is the primary health insurance plan, the other is the secondary. Claims are first submitted with the primary insurance. The secondary insurance pays for the remaining costs.

When two health insurance providers work together in this way to provide coverage, this is called coordination of benefits. Insurance providers can avoid duplicate payments for claims. This doesn’t mean that you get double the payments or reimbursements, but it may help cover healthcare costs if one plan has better coverage for a service than the other.

Supplementary insurance, like vision, dental, or accident coverage, is also sometimes referred to as secondary insurance.

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How does secondary insurance work?

Secondary insurance coverage is a backup, only coming into play after primary insurance pays out. It’s primary first, secondary next, covering what’s left or some of the insurance deductibles. This will depend on the rules, but it’s never more than what is left after the primary insurer processes the claims.

Who can have secondary insurance?

There aren’t eligibility requirements for secondary insurance coverage, except for the following situations:

Underage children whose parents health insurance: Parents can enroll their kids onto their plans. For the most part, it depends on which parents’ birthday comes first in the year. The later birthday is usually secondary.
Adults under age 26 with health insurance: The Affordable Care Act (ACA) allows children to remain on their parents’ plans until they’re 26 years old. It’s possible to cover such people with school or employer insurance. If this is the case, the school or employer insurance becomes their primary plan, with the parental one becoming the secondary.
Married adults or domestic partners with health insurance: Individuals who are married or in a domestic partnership with health insurance can add their partners on their plan. This means their partner has their own as well as their spouse’s.

What is the difference between primary and secondary insurance?

The difference between primary and secondary insurance is that primary insurance pays your medical claims first, secondary insurance then covers eligible remaining costs. This helps to maximize your overall coverage.

The key differences are in the table below:

Feature

Primary insurance

Secondary insurance

Order of payment

Pays first

Pays after the primary—steps in for remaining costs once primary pays

Purpose

Main source of medical coverage (for example, through employer or individual plan)

Supplemental—to fill gaps left by the primary (for example, uncovered services, remainder of costs)

Coverage Limits and Costs

Has its own deductibles, copayments, coverage limits, and exclusions

May also have its own deductibles and copayments. Covers what primary doesn’t, subject to its own terms

Eligibility

Often through employer or purchased directly

Often obtained with a spouse’s employer or bought separately

When it’s used

Always used first for medical claims

Used when primary is insufficient, for example, after limits reached or for excluded items

Coordination of benefits

Billed first—its payment doesn’t consider the secondary policy initially.

After primary pays, secondary pays the remaining balance. This is called “coordinating benefits”

Claim filing rules

Must file correctly (deadlines, documentation) to ensure claim acceptance

May only pay if claim is properly submitted after primary

If primary denies a claim

If denied, applicants may be left with costs or need to appeal

Employees can submit the claim to secondary, but it will only pay for what the policy covers

Can you choose which plan is primary and which is secondary?

The short answer is no, you can’t. As outlined above, an individual’s employer-sponsored plan will always be primary. Even if a spouse or parent’s plan has better coverage or maybe a lower deductible, you can’t submit claims to them first.

For minor children, if both parents have the same birthday or are divorced, individuals covered by the plans still won’t be the ones to choose.

If both parents have the same birthday, then the plan that has covered a parent the longest will be primary.
If parents are divorced or separated, then the birthday rule still applies unless superseded by a judge or divorce decree. Otherwise, the plan of the parent who has custody of the child will be designated as primary.

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