Can I Buy Two Dental Insurance Plans?

Dental insurance helps manage oral healthcare expenses, covering procedures from routine cleanings to complex treatments. Many individuals rely on these plans to make dental care more affordable and accessible. It is possible to have coverage under multiple dental insurance policies simultaneously. Understanding how such arrangements function helps individuals navigate their benefits and plan for potential costs.

Multiple Dental Coverages

It is generally possible for an individual to have more than one dental insurance plan active at the same time. This situation, often called dual dental coverage, commonly arises through various circumstances. For instance, an individual might have coverage through their own employer, while also being covered as a dependent under a spouse’s employer-sponsored plan. Another scenario involves holding two jobs, each providing its own dental benefits.

Dual coverage does not mean benefits are automatically doubled. Instead, insurers use a process called Coordination of Benefits (COB) to manage how payments are distributed between multiple plans. This ensures combined payments from all active plans do not exceed the total cost of dental services. While group (employer-sponsored) plans are typically required to coordinate benefits, individual policies generally do not participate in this coordination.

Coordination of Benefits Rules

Coordination of Benefits (COB) determines the order and amount of payments when a person has more than one dental plan. COB prevents overpayment on claims and ensures benefits are distributed fairly among insurers. One plan is always primary, paying its benefits first, while the other becomes secondary and considers the remaining balance.

Birthday Rule for Dependents

A common rule for dependent children covered by both parents’ plans is the “Birthday Rule.” Under this rule, the dental plan of the parent whose birthday occurs earlier in the calendar year is designated as primary. Only the month and day matter for this determination, not the year of birth. Exceptions to this rule can occur if a court order specifically dictates which parent’s plan is primary, or if parents share the same birthday, in which case the plan that has covered the patient the longest typically becomes primary.

Primary Plan for Adults

For adults with multiple plans, such as those with two employer-sponsored coverages, the plan where the individual is enrolled as an employee or main policyholder is usually primary. If an individual has two jobs, the plan that has provided coverage for the longest period is often considered the primary plan. In situations where a patient has a plan from current employment and another from a former employer, like a COBRA or retiree plan, the current employment plan is typically primary.

Non-Duplication of Benefits Clause

Some dental plans include a “non-duplication of benefits” clause, which can impact the amount the secondary plan pays. This clause means the secondary plan may pay nothing if the primary plan’s payment equals or exceeds what the secondary plan would have paid if it had been primary. For example, if both plans cover a procedure at 80% and the primary pays its 80%, a secondary plan with a non-duplication clause might not make any additional payment.

Claim Processing with Dual Plans

When an individual has dual dental coverage, the process for submitting and paying claims involves a specific sequence to ensure proper coordination. The dental office typically submits the claim to the primary insurance plan first. This primary plan then processes the claim according to its benefits, deductibles, and coverage limits.

After the primary plan has processed the claim and made its payment, an Explanation of Benefits (EOB) document is issued. This EOB details the services rendered, the amount charged by the dentist, how much the primary plan covered, and any remaining patient responsibility. The EOB from the primary plan is then necessary for the secondary plan to consider the remaining balance.

The secondary plan reviews the claim and the primary plan’s EOB to determine its own payment. The secondary plan’s payment calculation considers what the primary plan has already paid and applies its own benefit structure, including any deductibles or coinsurance. The combined payment from both the primary and secondary plans generally will not exceed 100% of the total covered charges for the dental procedure. This coordinated process aims to reduce the patient’s out-of-pocket expenses, though it does not mean that all costs will be eliminated.