Secondary Health Insurance Coverage - Aetna | What is it & How Does it Work? (2024)

As you probably know, your primary health insurance covers your basic medical expenses like doctors’ visits, lab tests and prescription drugs ― as well as some great perks. But your medical plan can’t cover everything. A separate plan that offers additional benefits is called secondary insurance.

Your secondary health insurance can be another medical plan, such as through your spouse. More often, it’s a different type of plan you’ve purchased to extend your coverage. In that case, you may hear it referred to as voluntary or supplemental coverage. All you need to remember is that primary and secondary plans work together to offer you coordinated benefits.

Different people need different supplemental plans, depending on their circ*mstances. Below, you’ll read how Peggy, Cecilia, DeWayne and Kevin use special policies to prepare for the unexpected financial and health challenges life sends their way.

Or watch this video to learn about the different coverage options available to you beyond your medical plan ― all in 60 seconds:

Health care answers in 60 seconds.

Why should you consider buying more than just a basic medical insurance plan?

Your medical plan will cover many expenses, but it won't cover everything. So, you may want special policies to help cover those extra costs.

For example, dental insurance typically covers routine teeth cleanings and preventive care as well as procedures like fillings and extractions. Vision insurance usually helps to cover the cost of prescription glasses, contact lenses, and routine eye exams.

Hospital indemnity insurance provides cash payments to help you manage the costs of a hospital stay, from your deductible to everyday expenses like daycare. If an injury or illness prevents you from working, disability insurance provides you with income on a weekly or monthly basis so you can still pay for your day-to-day expenses.

Health care question answered.

Dental plan: The mouth-body connection.

What goes on in your mouth can have an effect on your overall health. Regular dental care is especially important for people with diabetes, who are more prone to gum disease. Dental plans typically cover routine teeth cleanings and preventive care, as well as procedures like fillings and extractions.

Peggy, 38, is a married mom living in Raleigh, NC. A front desk agent at a local hotel, she bought dental insurance from her employer even though the family has medical coverage through her husband Jim. She’s glad she did: Peggy cracked a filling on a popcorn kernel and needs a repair. Since she chose a more comprehensive plan, she’ll pay only a fraction of the cost to get a new filling.

Within a week, a parent in her toddler’s play group gives her some news. Experts now recommend that little ones have their first dental appointment by age 1, or shortly after the first baby tooth comes in. Her 2-year-old son is overdue! Peggy is delighted to discover her plan covers her son’s visit.

Vision plan: A window into your overall health.

Vision plans usually cover routine eye exams and help cover prescription lenses (glasses or contacts) and frames. And like dental care, eye exams can also detect early signs of overall health problems, such as high blood pressure and lupus. That’s why it’s smart to see an eye doctor if even if you have 20/20 vision.

Cecilia, 27, is single and living in Miami, FL. The copy editor at a local magazine has worn prescription glasses since she was a young girl. She wants to update to a more stylish frame this year and knows that her vision plan gives her an annual frame allowance, as well as a reduction in the cost of prescription lenses. If she wanted to try out contacts, she could use her lens benefits for those instead. Either way, Cecilia will be looking her best and protecting her vision for the long term.

What supplemental coverage do I need?

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Hospital plan: Extra help when you need it most.

A hospital indemnity plans is a popular add-on to a High-Deductible Health Plan (HDHP). This supplemental plan gives you a lump-sum check if you’re admitted to the hospital. You can use it to pay for out-of-pocket medical costs such as deductibles and coinsurance, or toward non-medical expenses such as rent and utilities.

DeWayne, 49, is a divorced father living in Philadelphia. An accountant, he’s always weighing the financial considerations of every expense. He has an HDHP through his employer, and also opts for a hospital indemnity plan. Even though his family is healthy, he knows an unexpected hospital stay can run $10,000, and the additional plan would help pay for out-of-pocket expenses like his high medical deductible.

Not long after, DeWayne’s daughter is hospitalized with appendicitis. His hospital plan pays a lump-sum benefit that helps offset her medical bills ― and allows this father to focus on his little girl during her recovery.

Knowing that his family’s needs will be covered helps Kevin worry less and focus on healing.

Disability plan: Cover your expenses when you can’t work.

Disability plans come in handy when you’re injured or ill, because they cover a portion of your income for day-to-day expenses. Short-term disability coverage can last anywhere between 9 and 52 weeks. After that, long-term disabilty coverage can kick in.

Kevin, 52, married his high school sweetheart in their hometown of Jacksonville, FL, where they’re raising four kids. He rarely got sick ― until now. After feeling extremely fatigued, Kevin checked in with his Primary Care Physician, who found blockages in his arteries. A stent procedure was unsuccessful, so Kevin will have to undergo bypass surgery. Because he doesn’t have any other major health problems, his surgeon expects a full and speedy recovery. But he’ll be out of work for 8 to 12 weeks.

The family depends on Kevin’s income to cover their major expenses. Fortunately, he has a short- and long-term disability plan through his employer. Kevin will receive 60 percent of his income while he’s out of work, and the family will use savings and reduce expenses to help make up the difference. If all goes well, he’ll only need to use his short-term disability plan. If complications delay his recovery, he’ll start collecting long-term disability. Knowing that his family’s financial needs will mostly be covered helps Kevin worry less and focus on healing.

These are some of the insurance choices beyond your medical plan that you may want to consider. If you get health insurance through your job, your employer can tell you what additional plans are available to you. Some supplemental plans may also be available directly from insurance companies.

Secondary Health Insurance Coverage - Aetna | What is it & How Does it Work? (2024)

FAQs

Secondary Health Insurance Coverage - Aetna | What is it & How Does it Work? ›

If you're sick or injured, your bills can add up. Supplemental health plans put some money back in your pocket. You get cash benefits to help pay for the costs your medical plan doesn't cover, like copays and deductibles. Or you can use the cash to cover mortgage payments, groceries, utility bills and day care.

How does a secondary insurance work? ›

Secondary insurance plans work along with your primary medical plan to help cover gaps in cost, services, or both. Supplemental health plans like vision, dental, and cancer insurance can provide coverage for care and services not typically covered under your medical plan.

How does Aetna supplemental work? ›

The Health Supplement Plan pays cash benefits directly to you for services related to an accident, covered inpatient hospital stay and/or critical illness diagnosis while you are covered under the plan.

What does secondary mean in health insurance? ›

A separate plan that offers additional benefits is called secondary insurance. Your secondary health insurance can be another medical plan, such as through your spouse. More often, it's a different type of plan you've purchased to extend your coverage.

Does Aetna accept secondary claims electronically? ›

Did you know that we can accept your secondary, or coordination of benefits (COB), claims electronically, too? In fact, we prefer that you send us your secondary claims electronically. When you send us the right information up front, we process your secondary claims faster.

Is there a downside to having a secondary insurance? ›

Double the Fixed Costs

Two health insurance plans mean paying two premiums and deductibles. This situation means a greater monthly cost for premiums and a higher out-of-pocket cost to satisfy the deductible limit for each plan.

How do you determine which insurance is primary and which is secondary? ›

The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn't cover.

Does secondary insurance cover primary copay? ›

Secondary insurance pays after your primary insurance. Usually, secondary insurance pays some or all of the costs left after the primary insurer has paid (e.g., deductibles, copayments, coinsurances).

Does it make sense to have two health insurance plans? ›

Having two (or more) health plans can be a good choice if the savings you receive outweigh the costs. For example, if you have to pay the full premium to maintain each plan, and the premiums are high, the costs might outweigh the savings. But, many employers pay part of the premium, and your share may be low.

Is it good to get supplemental insurance? ›

But even with a more robust major medical policy that meets your needs and budget, supplemental insurance can be a good idea, especially if you have a family history of certain high-cost medical conditions.

What happens when a secondary insurance allows more than primary? ›

A credit balance results when the secondary payer allows and pays a higher amount than the primary insurance carrier. This credit balance is not actually an overpayment. The amount contractually adjusted off from the primary insurance carrier was more than needed, based on the secondary insurance carrier's payment.

What does coverage is secondary to your personal insurance mean? ›

"Secondary coverage" means that your credit card will only pick up the fees and charges that your primary car insurance policy doesn't.

What is the difference between primary secondary and supplemental insurance? ›

While your primary health insurance is the first to receive a medical claim, you may not have coverage for all lab work and treatments. This is when your secondary or supplemental insurance will help to pay for the rest of the costs.

Does Aetna deny a lot of claims? ›

The payer denied 93 percent of the emergency room claims that California investigated, underscoring that surprise billing remains a relevant issue during the coronavirus pandemic.

Can I use my Aetna extra benefits card at Walmart? ›

You can use the Aetna Extra Benefits card to buy groceries, household, and OTC items at eligible retail stores, like Kroger and Walmart. For transportation, utilities, and rent assistance, you can pay for the service directly with the card.

What is a secondary insurance claim? ›

Secondary insurance is when someone is covered under two health plans; one plan will be designated as the primary health insurance plan and the other will be the secondary insurance. The primary insurance is where health claims are submitted first.

What happens if secondary insurance pays more than primary? ›

A credit balance results when the secondary payer allows and pays a higher amount than the primary insurance carrier. This credit balance is not actually an overpayment. The amount contractually adjusted off from the primary insurance carrier was more than needed, based on the secondary insurance carrier's payment.

Do I have to meet my deductible before secondary insurance pays? ›

Secondary insurance pays after your primary insurance. Usually, secondary insurance pays some or all of the costs left after the primary insurer has paid (e.g., deductibles, copayments, coinsurances).

Can I have my own insurance and be on my parents at the same time? ›

Yes, you can have your own health insurance plan while staying on your parents' policy. This is called having dual coverage.

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