What Is Supplemental Health Insurance? – Forbes Advisor

Health insurance covers the cost of preventative care, surgeries, doctor appointments, prescriptions, urgent care and much more. While many health insurance plans offer robust coverage, health insurance won’t cover all potential costs of getting sick.

Supplemental health insurance can fill some gaps.

As the name suggests, supplemental health insurance is designed to “supplement” existing health insurance plans. Supplemental plans don’t replace health insurance. They may help pay for health care costs not covered by a plan or provide additional coverage for specific needs like dental care, vision and long-term care.

How Does Supplemental Health Insurance Work?

Supplemental health insurance fills gaps in a traditional health insurance plan by providing coverage for certain expenses for which you’re responsible. Supplemental plans don’t typically cover medical treatments, such as surgeries or medications.

A supplemental plan may instead help pay health insurance deductibles or copayments, or pay for specific care, such as cancer or critical illness. Supplemental health insurance plans work differently than health insurance plans, but the specifics depend on the plan.

A supplemental policy like dental insurance may help pay for your dental care. Or a policy like critical illness insurance may give you a lump sum payout as reimbursement for the out-of-pocket costs associated with your treatment. This money can be used for any purpose, including medical bills, transportation, childcare, food or housing.

What are Types of Supplemental Health Insurance?

There are multiple types of supplemental health insurance that can provide coverage in different situations. You can purchase supplemental plans to complement your group health insurance or private health insurance policy. The cost and benefits vary depending on the plan and the provider.

Here are some of the most common supplemental health insurance plans available.

Accident insurance

If you have an accident that is covered by an accident insurance policy, it can pay for the expenses that your regular health plan policy excludes. Your injury must meet the qualifications based on the accident plan details. Broken bones, burns, concussions and paralysis are just a few examples of covered conditions.

In addition, many accident insurance policies provide a payout in the event of an accidental death. If you pass away and your death is caused by an accident covered by the policy, a beneficiary of your choosing would receive a lump sum payout, similar to a life insurance death benefit.

Cancer insurance

If you get diagnosed with cancer, having a supplemental cancer insurance policy provides money that you can use for any need. Cancer insurance benefits can be used for:

• Copays
• Deductibles
• Transportation to and from chemotherapy appointments
• Groceries
• Rent or mortgage payments
• Cancer treatments that aren’t covered by your health insurance

Critical illness insurance

If you get diagnosed with a qualifying critical illness, a supplemental critical illness plan can help pay for the out-of-pocket costs that your regular health insurance plan doesn’t cover. For example, if you had a kidney transplant, you could use critical illness insurance benefits to pay for your mortgage, groceries or child care while you recover.

Supplemental critical illness insurance generally covers many major illnesses, including:

• Stroke
• Heart attack
• Cancer
• Organ transplant
• Coma
• Loss of hearing, vision or speech
• Paralysis
• Coma
• Renal failure

Dental and vision insurance

Most standard health insurance plans don’t include dental or vision benefits. If you want coverage for visits to the dentist or optometrist, consider a supplemental dental insurance or vision insurance plan.

Of all the supplemental insurance policies, dental and vision insurance are two of the most common. These policies cover preventative care (like two dental cleanings per year), as well as other expenses, such as contact lenses or prescription glasses. Dental and vision insurance are usually relatively inexpensive and are sold by many health insurance companies.

Disability insurance

Disability insurance provides income replacement if you become disabled and can’t work. You can purchase supplementary short-term disability insurance or long-term disability insurance. The difference between the two plans is how long the insurance company will provide benefits.

To use disability insurance benefits, you must prove your disability, which often requires verification from a doctor or a medical professional. Depending on the disability insurance plan, you may elect to receive compensation on a weekly or monthly basis. You will stop receiving income replacement when your benefits run out or when you can return to work.

Hospitalization insurance

Although traditional health insurance plans cover hospitalization, your plan might not cover the entire stay. If your benefits run out, a supplemental hospital insurance plan can provide additional coverage for the portion that’s not covered by your primary policy.

The average cost of a three-day hospital stay is roughly $30,000, according to the federal government’s Healthcare.gov. That can take a big chunk out of your wallet. Hospital insurance, which is also called hospital indemnity insurance, can help pay for the cost of hospitalization.

Depending on the plan, hospital insurance may provide a fixed benefit for an entire hospital stay or it might provide a certain amount of coverage for each day you spend in the hospital.

Long-term care insurance

Supplemental long-term care insurance helps cover the cost of long-term care services, which may be necessary if you are diagnosed with a chronic illness. Some of the expenses that a long-term care insurance policy will pay for include:

• Home health aides
• Nursing homes
• Assisted living facilities
• Adult day cares

To use long-term care insurance benefits, you’re typically required to meet certain criteria. For example, many plans will provide benefits when you can’t perform two out of the six activities of daily living (ADLs), such as bathing, eating or dressing.

How Does Supplemental Health Insurance Fill in the Gaps of Health Insurance?

The purpose of supplemental health insurance is to provide coverage for certain expenses that a traditional health plan excludes.

Even with the best health insurance plan, you’re still likely responsible for some treatment costs. Depending on the situation, a sudden medical diagnosis can cause financial strain. Supplemental health insurance plans provide a payout to ease the financial burden of these situations.

For instance, imagine that you get into a car accident and have a concussion. A typical health insurance policy would cover at least a portion of the cost of treatment, like an MRI and an overnight hospital stay. However, if the concussion was serious enough that you couldn’t work for a month, disability insurance would provide income replacement during that time.

Supplemental health insurance plans aren’t meant to replace your primary health insurance policy. Your health plan will always provide more robust coverage for medical care, but having supplemental insurance can provide additional funds for the expenses that you would normally have to pay for out of pocket.

How Much Does Supplemental Health Insurance Cost?

Most supplemental health insurance plans are less expensive than regular health insurance policies. However, the cost of supplemental health insurance depends on a variety of factors, including:

• Plan type
• Location
• Age
• Insurance company
• Benefits

The premium also depends on how you purchase the plan. For example, if you get disability insurance through your employer, the premium would likely be subsidized. If you buy a private disability insurance plan, you pay 100% of the premium out-of-pocket.

When shopping for supplemental health insurance, it’s a good idea to get health insurance quotes from a few different companies and compare them.

Supplemental Health Insurance FAQ