November 10, 2015 - Reflex Knee Specialists

Did you know that in addition to your primary health insurance policy, you can also have a secondary or supplemental plan? While a secondary or supplemental plans sound similar to each other, they function very differently. In this week’s blog, we break down the differences between these types of insurance policies, so you can determine if either would be right for you. Supplemental Plans: The biggest difference between supplemental and secondary insurance plans is that supplemental plans cannot function as a standalone policy. As the name suggests, this type of policy helps to supplement your primary plan, which you may have purchased through the federal and state exchanges or obtained through your employer. One of the benefits of supplemental plans is that the premiums are much lower than a primary or secondary insurance plan. If your primary policy doesn’t cover certain procedures or providers, a supplemental plan could be helpful for paying copayments, co-insurance, and the primary deductible, which would reduce your out of pocket costs for the year. However, for many families or individuals under 65, simply purchasing a primary plan with the right coverage is the most cost effective approach – supplemental plans are primarily beneficial for those on Medicare or state funded programs and policies. It’s important to remember that you can still end up with a remaining balance for medical bills with supplemental plans, because they aren’t as robust as standalone policies. Depending on the type of plan (e.g., HMO), your supplemental policy may only provide coverage for certain providers, or not have coverage outside of certain regional areas. Secondary Plans: Unlike supplemental plans, a secondary plan is a comprehensive policy and can function as a standalone plan if necessary. If you do have a primary and secondary plan, it’s important to coordinate benefits between the two. For example, if you have one plan through your work (primary plan), and one through your spouse (secondary), you must always submit medical claims to your primary policy first. After the claim has been processed, your primary providers will need to send the claim to your secondary policy provider. It’s possible that your secondary plan will pay for the balance of anything not covered by your primary plan, but it cannot pay anything towards the primary deductible. As your secondary plan may also have a deductible of its own you may need to pay for both deductibles before any coverage kicks in. Since these plans could both function on their own, you’ll likely pay for redundant coverage, which will cost a premium price. However, if the first plan doesn’t cover certain services, treatments, or providers, you can try to submit it to your secondary plan, which may cover the services you need. Make Insurance Decisions with Confidence Whether you’re thinking of changing your insurance policy or are starting on Medicare, our insurance specialists can help you determine which plans cover treatments at Reflex. We are happy to help you. If you are struggling with chronic or intermittent knee pain that is affecting your daily life, call to schedule an appointment with one of our specially trained physicians today at (503) 719-6783.

Secondary Plans – Understanding Health Insurance, Part 5

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