What Do Primary (aka “First Payer”) or Secondary (Excess) Medical Coverage Mean and How Do They Differ?

Primary (aka “First Payer”) Medical Coverage means your medical bills are paid from the first dollar. No “coordination of benefit” claim forms need to be filed. You need to know that many travel insurance plans with primary (aka “First Payer”) medical benefits will still ask on the claim forms if you have other medical insurance. If you answer “yes”, they will likely submit your claim to your other insurance first and process your claim as Secondary coverage.

Primary (aka “First Payer”) Medical Coverage works best if your medical claim is less than the coverage amount. That’s because your travel insurance will pay the claim up to its limit. But, when the Primary travel insurance benefits are exhausted, your other insurance won’t count your deductibles and co-pays as paid.

For example, here’s what happens if you have a $70,000 medical claim with a travel insurance plan that has $50,000 Primary (aka “First Payer”) coverage:

1. You submit the $70,000 medical claim to the travel insurance. It pays $50,000 (its maximum)
2. You submit the remaining $20,000 to your medical insurance plan. Let’s say it has a $5,000 deductible with a 20% copay.
3. Of this $20,000, your medical insurance plan pays $12,000 and you will be liable for at least that $8,000 ($5,000 deductible & $3,000 copay). You could be liable for more. Here’s how: Gayle B. says: “I work for Blue Cross Illinois. Please keep in mind if your travel insurance pays primary to the providers, those medical providers do not have to apply the Blue Cross discount so the billed charges may be quite higher. I would check carefully and call your Blue Cross customer service number on the back of your ID card before you make a decision”.

Secondary Medical Coverage means your medical bills are paid after any other coverage you have pays its share. This means that Secondary coverage will pay any deductibles, out-of-pocket expenses or co-pays up to its coverage limit. The only real drawback to a Secondary Medical plan is that it can be a lot of extra time-consuming paperwork, made worse by complicated prescription benefits.

For example, here’s what happens if you have a $6,000 medical claim ($5,500 medical & $500 prescriptions) with a travel insurance plan that has $25,000 Secondary coverage:

• You submit the $6,000 medical claim to your medical insurance plan. Let’s say it has a $1,000 deductible with a 20% copay and a $500 prescription deductible
• You get your medical EOB (explanation of benefits), but not your prescription EOB
• You get your prescription EOB
• You submit the amounts shown as “Patient’s Responsibility” to the travel insurance. Unless you already satisfied some or all your deductibles, you’ll be claiming payment for $4000 (80% of the remainder of this: $6,000 – $1,000 medical deductible & $500 prescription deductible)

Here’s a little detail that’s good to know: You probably will have to pay your medical bills yourself while on your trip. That’s because travel insurance plans are “indemnification” plans (you will be reimbursed – indemnified) after your trip by the insurance company. Travel insurance is not a “pay on behalf of” plan. You don’t just give the medical facility a card. In some cases, a few companies can advance payment to the medical facility, but it’s on a case-by-case basis.

Here’s another little detail that’s good to know: Secondary coverage assumes you have other coverage that’s Primary. If you have no other coverage Secondary, in effect, becomes Primary.

How Much Emergency Medical Coverage is Enough?

There are a few things you need to find out before you settle on an amount of Emergency Medical / Dental and Emergency Medical Transportation coverage.

• What other coverage do you have? If you’re a US Citizen & have Medicare, Medicare doesn’t cover you outside the USA.
• If you have individual or group insurance, what are your deductibles & copays if you’re outside your provider’s service area? This is similar to “Out of Network” benefits. Here’s a good way to find out exactly how your regular insurance covers you.
• Will your current medical coverage pay before or after a Travel Insurance plan? If your current medical pays before other insurance you can then submit your out of pocket costs to the travel insurance for reimbursement. On the other hand, if your current insurance pays after a Travel Insurance plan (meaning the Travel Insurance is Primary), then you don’t have to wait for your current insurance to finish its claim before the travel insurance pays.

A common myth is that Primary plans cost more than Secondary plans. The actual cost of Travel Insurance is based on your age, trip cost and trip length. Some Primary plans are less expensive than Secondary plans at certain ages and vice versa for other ages.

One more thing to be aware of is that the emergency medical transportation portion of a policy doesn’t pay for the medical treatment. That’s covered under the emergency medical portion of the travel insurance policy.

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