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Understanding primary and secondary insurance
Having one insurance policy can be challenging enough to figure out, but what if you have coverage from two? With two insurance providers, it's important to know how to navigate your primary and secondary insurance. While it can be advantageous to have two policies to cover your type 1 diabetes (t1d) care and other health needs, understanding how they work together is key to ensuring your claims are processed properly and without incident.
How do people end up with primary and secondary health insurance coverage?
Most people don't go out of their way to find secondary coverage. Instead, they may find themselves in a situation where they have an opportunity to be covered in two places. Some common situations may include:
- Employer-based plan plus spousal coverage
- Children covered under both parents' plans
- Young adults (under age 26) with employer-based coverage and parental coverage
There are other ways you could have double coverage (and many rules around how it works in different situations), so if you don't see your situation listed above, your insurance companies can help you sort out the details that apply to your unique situation.
What to know about having two health insurance policies
If you find yourself with health insurance from two separate sources, you need to know which of the plans is considered the primary and which is the secondary. The primary is the plan that pays first, with the secondary coming in after to pick up a portion or all of the remaining amount due after the primary has processed the claim.
The process of two insurance companies working together to pay claims for the same person is often referred to as coordination of benefits. If you ever need to call to follow up on a claim, you may want to keep this phrase in mind to help you get to the right person more quickly.
If you live with t1d, it can be helpful to explore the potential benefits of double coverage if readily available since annual costs of care can be high. For example, you could use both policies to cover durable medical equipment. If you're using a continuous glucose monitor (CGM), the primary insurance will be billed first. After the primary insurance processes the claim, the secondary coverage may pay all or part of the remaining balance. Anything that's left unpaid after both policies have processed the claim is your responsibility.
Tips for people with primary and secondary insurance coverage
If you have primary and secondary insurance, here are some things to keep in mind:
- Be aware that you can't choose which of your plans to be primary and secondary, as there are extensive rules that determine this for you.
- Establish with your healthcare provider's billing department which policy should be billed as the primary and secondary insurance to help avoid errors.
- Keep an eye out as claims are paid to make sure your policies are billed appropriately.
- Know that if you have private health insurance coverage in addition to Medicare, Medicaid, or Tricare, the other policy will generally be considered the primary insurance.
Stay organized with your insurance
Keeping track of bills and claims processing under one insurance policy can be challenging, and with two plans, there will always be more to stay on top of over time. However, utilizing organizational tools like a spreadsheet and online insurance portals can help you stay organized while making sure your claims are processed appropriately.
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