Can Kaiser be Used as Secondary Insurance? A Complete Guide

Having multiple health insurance plans can provide more comprehensive coverage, lower costs, and give you access to a wider range of providers. A common question that comes up is whether Kaiser Permanente health plans can be used as secondary insurance.

The answer is yes – Kaiser can serve as secondary insurance when paired with another primary health plan. Here’s an in-depth look at how it works and tips for maximizing your benefits.

What is Secondary Insurance?

When you have coverage under two health plans, coordination of benefits rules determine which plan pays first (primary) and which pays second (secondary). The secondary plan covers costs after the primary insurance pays its share.

Secondary insurance helps fill gaps in coverage and provide additional reimbursement. It essentially acts as a supplement to your primary plan.

Some key things to know:

  • Claims go to primary plan first, then any unpaid costs get submitted to secondary

  • You must follow each plan’s rules and networks, even when not primary

  • Pre-approvals, referrals, deductibles and out-of-pocket limits apply separately

  • Pediatric dental/vision benefits usually paid by secondary plan first

Having secondary insurance provides an extra layer of financial protection and often lowers your overall health expenses.

Is Kaiser Compatible as Secondary Insurance?

Kaiser Permanente health plans can certainly serve as secondary insurance when paired with another carrier’s primary policy.

Some key points about using Kaiser as secondary:

  • Applies to group, individual, Medicare Advantage plans

  • Must follow Kaiser’s authorization rules and use in-network providers

  • Kaiser pays as secondary based on benefits, limitations of your plan

  • You’re responsible for Kaiser deductibles, copays, coinsurance

  • Claims should be submitted to primary plan first, then Kaiser

  • Customer service can assist with coordinating benefits

While being secondary payer, Kaiser still requires following plan protocols and network rules. This ensures you receive maximum reimbursement from both policies.

What Types of Primary Plans Can Kaiser Pair With?

Kaiser health plans are compatible with a wide range of major medical insurance carriers as the secondary payer. Some examples of primary plans Kaiser can coordinate benefits with:

  • Employer group health plans

  • Individual plans (e.g. Blue Cross, Cigna, Aetna)

  • Federal Employee Health Benefits (FEHB)

  • TRICARE and military health benefits

  • Medicaid plans in some states

  • Medicare Advantage and Medigap plans

  • University student health insurance

As long as the primary coverage is comprehensive major medical insurance, Kaiser can typically serve as secondary overpayer. Exceptions may apply for limited benefit plans.

Coordinating Kaiser with Employer Group Health Plans

Using Kaiser as secondary insurance alongside an employer plan is a common scenario. Here are some tips:

  • Verify both plans are active before dual enrollment

  • Understand each plan’s coverage details, networks, costs

  • Have ID cards available for both carriers

  • Check if referrals required for specialists with primary plan

  • Get pre-approvals from primary insurer first if needed

  • Submit claims to primary carrier, then Kaiser for leftover costs

  • Keep records of EOBs from both insurers

  • Reach out to both plan admins with coordination questions

Coordinating with an employer plan requires understanding how both policies work together. But the dual coverage provides significant savings in many cases.

Pairing Kaiser with Individual or Family Plans

Individuals and families buying their own plan on or off the marketplace can also use Kaiser as secondary coverage:

  • Shop for an ACA-compliant plan as primary during open enrollment

  • Apply for subsidies if eligible based on income

  • Pick Kaiser as secondary for access to different providers/facilities

  • Make sure to comply with rules of both plans

  • Check if can switch between primary and secondary each year

Purchasing your own policy along with Kaiser gives flexibility to change plans annually and align benefits for the best value.

Coordinating Kaiser with Medicare

For seniors with Medicare, Kaiser can supplement coverage as secondary:

  • Enroll in Kaiser’s Medicare Advantage program

  • Remain on Original Medicare and add Kaiser Senior Advantage

  • Use Kaiser’s Medigap plans for secondary coverage

  • Must keep paying Medicare Part B premium

  • Follow Medicare rules if it’s the primary payer

Kaiser Medicare plans integrate directly with Original Medicare as secondary insurance. This provides affordability along with access to Kaiser’s services and network.

Is Kaiser Good as Secondary Insurance?

Kaiser can make an excellent secondary insurance plan due to some of these advantages:

  • Large regional networks with comprehensive care

  • Benefits like prescription drugs, mental health

  • No deductibles with many Kaiser plans

  • Low copays and out-of-pocket costs

  • Coverage out of area for emergencies

  • Routine care without referrals or pre-approvals

  • Medicare Advantage and Medigap plan options

  • Provider teams focused on care coordination

For those seeking an affordable complement to primary insurance, Kaiser offers value through it’s integrated model.

Submitting Claims with Kaiser as Secondary

To receive reimbursement, claims should first be submitted to your primary insurance. Here’s the process when Kaiser is secondary:

  • Present both insurance cards when getting medical care

  • Provider bills primary plan first

  • Primary insurer pays covered amount, sends you an EOB

  • Remaining costs can then be billed to Kaiser

  • You pay Kaiser deductibles, copays, coinsurance

  • Keep the EOBs for coordination of benefits

Following this claims submission order results in each plan paying its appropriate share. It’s important to confirm coverage details ahead of large medical expenses.

Who is Eligible for Kaiser as Secondary Insurance?

To use Kaiser as secondary coverage, you must meet eligibility for one of Kaiser’s plan types:

  • Group plans: Get coverage through employer, union, or other organization

  • Individual and family: Buy directly from Kaiser or your state marketplace

  • Medicare Advantage: Enroll if have original Medicare Parts A/B

  • Medigap: Purchase Kaiser Medigap plan to supplement Medicare

As long as you meet the member requirements for a Kaiser plan, you can add it as secondary insurance no matter your primary coverage.

Strategies to Maximize Dual Healthcare Benefits

Here are some tips to make the most of having Kaiser as secondary insurance:

  • Compare plan benefits side-by-side and identify overlaps or gaps

  • Consider using each plan’s strengths, like primary for hospitals and Kaiser for prescriptions

  • Check if you can switch plans to be primary or secondary each year

  • Make sure you understand referral, pre-approval and claim submission processes

  • Ask about continuity of care if providers are not in-network

  • Discuss required medical expenses with both insurers in advance

  • Automate premium payments and regularly review statements for accuracy

  • Report life changes like marriage, newborn, or address update to both carriers

Coordinating coverage takes effort but offers advantages in premium savings, lower cost-sharing, provider choice and financial protection.

Frequently Asked Questions about Kaiser as Secondary

Here are answers to some common questions about using Kaiser as secondary insurance:

Does my Kaiser deductible and out-of-pocket limit apply separately?

Yes, your Kaiser plan’s cost-sharing applies exclusively to what Kaiser covers as the secondary payer.

What if a service isn’t covered by my primary insurance?

If your primary plan doesn’t cover a service, you can submit the claim to Kaiser for secondary payment based on your benefits.

Can I get referrals from Kaiser if required by the primary insurer?

You may be able to get referrals from Kaiser to satisfy the primary plan’s requirements. But referrals are provided at Kaiser’s discretion.

Is Kaiser’s pediatric dental covered if it’s secondary to another dental plan?

It depends. Kaiser may provide secondary pediatric dental benefits, but will coordinate with the primary dental insurer.

Can I enroll in Kaiser then drop my other health coverage?

You must maintain the qualifying primary insurance plan to have Kaiser as secondary. Dropping the primary plan will lead to loss of the secondary Kaiser coverage.

What if both plans deny a claim for coverage?

In rare cases of neither plan covering a service, you may need to appeal determinations or be responsible for the cost. Checking benefits ahead of time can prevent denials.

Enrolling in Kaiser as Secondary Insurance

To get Kaiser coverage as a secondary plan:

Employer Group: Enroll during open season through your employer.

Individual: Apply during open enrollment or special enrollment periods in your state insurance marketplace.

Medicare: Enroll in Kaiser’s Medicare Advantage program as a supplement to original Medicare.

Kaiser will coordinate with your primary carrier once dual coverage begins. Having Kaiser as secondary insurance provides affordability along with expanded access when you need care.

Individual Guide to Medicare Basics | Kaiser Permanente


How does Kaiser double coverage work?

Dual Medicare and Medi-Cal coverage can give you extra benefits and better value. If you have both Medicare and Medi-Cal, you’re eligible for extra benefits. Kaiser Permanente Medicare Medi-Cal Dual Special Needs (D-SNP) plans let you keep your Medi-Cal benefits and get more benefits than Original Medicare.

Can you have medical and Kaiser at the same time?

Learn about Medi-Cal with Kaiser Permanente Kaiser Permanente participates in Medi-Cal in many counties. This means that, if you are a current Kaiser Permanente member and your situation changes, you may be able to keep your same doctor and continue your care with Kaiser Permanente if you qualify for Medi-Cal.

How do you determine secondary insurance?

The parent’s plan with the earlier birthday in the calendar year is considered primary. The person with the later calendar year birthday is secondary. The birthday rule is strictly about the calendar year—not the birth year. A child under 26 has their own plan and is covered by a parent.

Which insurance is primary when you have two?

Usually, your employer’s plan is primary. If you also are covered by your spouse’s plan, that plan is usually secondary. There are other rules for many other situations. A special case may come up if you have both medical and dental insurance, and you have a procedure such as oral surgery.

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