When it comes to health insurance, understanding your coverage can be confusing. One aspect that can be particularly confusing is determining which insurance is considered primary and which is secondary. In this article, we will break down what primary and secondary insurance coverage means and how to determine which insurance is primary and secondary.
What is Primary and Secondary Insurance Coverage?
Primary and secondary insurance coverage refers to the order in which insurance companies will pay for your medical expenses. Primary insurance is the first insurance company that will pay for your medical expenses, while secondary insurance will cover any remaining costs that are not covered by your primary insurance.
How Does Primary and Secondary Insurance Work?
Let’s say you have two health insurance plans, one through your employer and one through your spouse’s employer. If you were to have a medical procedure that costs $10,000, your primary insurance would cover the majority of the cost, leaving you with a smaller portion to pay out of pocket. Your secondary insurance would then cover the remaining balance, if any.
Determining Primary and Secondary Insurance
Determining which insurance is primary and which is secondary can be confusing, but there are a few key factors to consider.
Coordination of Benefits
The first step in determining primary and secondary insurance is to look at the coordination of benefits (COB) clause in your insurance policies. This clause outlines how your insurance companies will work together to pay for your medical expenses.
In most cases, the insurance policy of the primary policyholder will be considered the primary insurance. For example, if you are covered under your spouse’s insurance plan, their insurance will be considered primary, and your insurance will be secondary.
Birthday Rule
If both you and your spouse have insurance through your employers, the birthday rule may come into play. This rule states that the insurance of the policyholder with the earlier birthday will be considered primary. For example, if your birthday is in January and your spouse’s birthday is in March, your insurance will be considered primary.
Dependent vs. Employee Coverage
If you have insurance through your employer and are also covered under your spouse’s insurance, your employer’s insurance will be considered primary. This is because your employer’s insurance is considered dependent coverage, while your spouse’s insurance is considered employee coverage.
Medicare and Medicaid
If you have both Medicare and Medicaid, Medicare will be considered your primary insurance. Medicaid will then cover any remaining costs that are not covered by Medicare.
What Happens if You Have More Than Two Insurances?
In some cases, you may have more than two insurances. In this situation, the order of primary and secondary insurance will depend on the specific policies and coordination of benefits clauses for each insurance.
How to Use Primary and Secondary Insurance
Now that you understand how to determine primary and secondary insurance, it’s important to know how to use them effectively.
Inform Your Healthcare Providers
When you visit a healthcare provider, it’s important to inform them of all the insurance coverage you have. This will ensure that they bill the correct insurance as primary and secondary, which can save you from having to pay out of pocket for any remaining costs.
Keep Track of Your Medical Expenses
It’s important to keep track of all your medical expenses, including what is covered by your primary and secondary insurance. This will help you understand how much you are responsible for paying and can also be useful for tax purposes.
Understand Your Coverage
Make sure you understand the coverage of both your primary and secondary insurance. This will help you make informed decisions about your healthcare and can also help you avoid any unexpected costs.
What if You Don’t Have Insurance?
If you don’t have insurance, it’s important to explore your options. You may be eligible for government-funded programs such as Medicaid or Medicare, or you may be able to purchase insurance through the Health Insurance Marketplace.
News
Federal civil rights investigators are probing recent cyberattacks on a healthcare organization to ascertain if protected health information was compromised. The Office for Civil Rights will also assess the company’s adherence to patient privacy laws. A provider of technology for insurance claims processing, experienced disruption to its systems last month, prompting concerns about billing and care authorization nationwide. Meanwhile, cybersecurity experts warn of the rising threat of ransomware attacks, particularly in the healthcare sector.
Conclusion
Understanding primary and secondary insurance coverage is an important aspect of managing your healthcare expenses. By knowing how to determine which insurance is primary and secondary and how to use them effectively, you can save yourself from unexpected costs and make informed decisions about your healthcare. If you have any questions about your insurance coverage, be sure to reach out to your insurance provider for clarification.
