What’s the Difference Between Primary and Secondary Coverage?

UPDATED: Nov 14, 2011

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UPDATED: Nov 14, 2011Fact Checked

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Asked November 14, 2011

1 Answer

The most common way for a person to have two health insurance plans is when you and your spouse both belong to separate employer-sponsored group insurance plans. If you happen to become covered under two different health insurance plans, one will be your primary coverage and the other will be the secondary. Having multiple plans can become a problem unless they are handled correctly.

In most cases, your primary plan will be the one you had first, or the one you subscribed to through your employer. If you are given the option of choosing, compares the two coverage plans and select the one that provides the most benefits or waives the need to make copays.

Your primary coverage is the insurance plan you will use. You will have to see the doctors in that network, and meet the plan requirements such as paying deductibles and copays. This is the health insurance you should claim on forms and applications, and treat as the only health plan you will use.

Secondary coverage generally remains unused until you have used up all of the benefits of the primary plan. Once those benefits are gone, your secondary coverage will kick in, covering the medical costs where the other coverage left off. When that happens, you will have to obey the rules of that plan, including seeing doctors in the network and paying the specified out of pocket costs.

You can also purchase special-purpose secondary coverage. One example of this would be a health plan for your prescriptions that are not covered under the primary plan. Another type of secondary coverage might be for dental care or to manage a pre-existing condition that is excluded from your primary coverage.

Be careful not to ever use both plans for the same purposes. If you do, then you run the risk of both insurers claiming they are the secondary plan and laying the burden of health care on the other. Instead of the plans complementing each other, they cancel out and you are left with no clear recourse for paying for your medical care.

Answered November 14, 2011 by Anonymous

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