Many people have access to health care coverage through a primary insurance and a secondary insurance plan. Having more than one insurer covering medical costs can have its benefits. The number of primary and secondary insurance combinations you might have include:
- Primary commercial plan, secondary commercial plan
- Primary commercial plan, secondary Medicare
- Primary commercial, secondary medical assistance
What Is the Difference Between Primary and Secondary Insurance?
UPMC is in-network with most major insurers, including Aetna, Cigna, Highmark, United Healthcare, and UPMC Health Plan. However, it’s important to understand how primary and secondary insurance work and their differences, so you can make the best health care decisions.
Primary insurance is a health insurance plan that covers a person as an employee, subscriber, or member. Primary insurance is billed first when you receive health care. For example, health insurance you receive through your employer is typically your primary insurance.
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Secondary insurance is a health insurance plan that covers you in addition to your primary insurance plan. Typically, secondary insurance is billed when your primary insurance plan is exhausted and may help cover additional health care costs. For example, if you already have insurance through your employer and choose to enroll with your spouse’s health insurance plan (if allowed), that coverage would become your secondary insurance.
Who Is Eligible for Secondary Insurance?
Most people have a primary insurance plan, but not everyone has or needs a secondary insurance plan. However, secondary insurance can be beneficial for those who qualify, including:
- Married couples with separate health plans
- Children with health plan coverage under each parent
- Children under age 26 with a health plan through an employer who also are covered by their parents’ plan
- Children under age 26 who are married and on a spouse’s policy and their parent’s policy
- A child under age 26 who is pregnant and on a parent’s health plan
- An injured worker who qualifies for worker’s compensation and has an employer health plan
- A senior who is covered under Medicare and has a private health insurance plan
- A person who qualifies for Medicaid and has a private health insurance plan
- Veterans covered under Veterans Administration (VA) benefits and a private health insurance plan
- Servicemen and women with military coverage who also have another health insurance plan
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Why Would I Need Two Health Plans? What Are the Benefits?
Your secondary insurance takes effect when your primary insurance is exhausted. This means the primary insurance has covered everything it is obligated to pay under your policy and will not be covering additional services.
For example, you need physical therapy but your primary insurance only covers a limited number of sessions. If your doctor thinks you need more sessions, your secondary insurance may cover the remaining physical therapy sessions. Other benefits of secondary insurance can include coverage of:
- Deductibles and copays
- Dental or vision services
- Critical care for injuries, cancer care, and other unexpected occurrences
Can I Choose Which Insurance Plan I Want to Use?
Your primary insurance is always billed first. That means you cannot choose which insurance is used when you schedule or receive health care services. It is important to make sure your health care services are provided in-network under your primary insurance. If your primary insurance considers the provider to be out-of-network, your secondary insurance may also consider that provider out-of-network.
Questions about your current policy and coverage are best directed to the appropriate representative at your workplace, such as a supervisor or human resources representative, or by calling the customer service number on the back of your insurance card.
If you are looking to make changes to your coverage, it is important to note when your company will have open enrollment. You can also ask when you are able to make changes outside of open enrollment, possible in such circumstances as having a baby or getting married.
Finally, most major insurance companies offer plans with full, in-network access to UPMC, including Aetna, Cigna, Highmark, United Healthcare, and UPMC Health Plan.
If you have questions about in-network access to UPMC, please call our help line at 1-855-646-8762.
Based in Pittsburgh, UPMC is a world-renowned health care provider and insurer. We operate 40 hospitals and more than 700 doctor’s offices and outpatient centers. Our expert physicians are among the leaders in their fields, and we are leaders in groundbreaking research and treatment breakthroughs. UPMC Presbyterian Shadyside ranks as “One of America’s Best Hospitals” and No. 1 in Pennsylvania in U.S. News & World Report’s listings.