Can I Get Secondary Dental Insurance?

Secondary dental insurance can supplement an existing primary dental plan, allowing for broader benefits and potentially reduced out-of-pocket expenses. This article clarifies what secondary dental insurance entails and how these multiple plans interact to cover dental care costs.

Exploring Secondary Dental Coverage

Secondary dental coverage refers to an additional dental insurance policy an individual holds concurrently with an existing primary plan. This arrangement is commonly sought when a primary dental plan may not fully meet an individual’s or family’s extensive dental care needs. For instance, a primary plan might have annual maximums that are easily reached, leaving patients responsible for significant costs beyond this limit.

Individuals might also consider a second policy to gain access to a wider network of dental providers or to cover specialized services not adequately addressed by their initial plan. Some primary plans might exclude or offer limited coverage for major procedures like crowns, bridges, or orthodontics. A secondary policy can help bridge these gaps, contributing towards the cost of treatments that would otherwise be entirely out-of-pocket.

Another common scenario involves reducing personal financial contributions for extensive dental work. When a significant procedure is anticipated, such as a root canal or oral surgery, the combined benefits of two plans can substantially lower the amount a patient must pay. A secondary policy aims to enhance overall coverage, minimize financial exposure, and ensure comprehensive access to necessary dental services.

How Multiple Dental Plans Work Together

When an individual has two dental plans, their interaction is governed by a process called Coordination of Benefits, or COB. COB rules establish which plan pays first (the primary insurer) and which one pays second (the secondary insurer), ensuring that the total reimbursement does not exceed 100% of the dental service cost. This prevents individuals from profiting from their insurance coverage.

The primary insurer is responsible for paying its portion of the claim first, based on its own terms and benefits. Once the primary plan processes the claim and issues an Explanation of Benefits (EOB), this documentation is then submitted to the secondary insurer. The secondary plan then reviews the remaining balance and applies its benefits, potentially covering some or all of the leftover costs, up to its own policy limits.

Determining which plan is primary follows specific guidelines. For an individual covered by their own employer’s plan and as a dependent on a spouse’s plan, their employer-sponsored plan is primary. For dependent children covered under both parents’ plans, the “birthday rule” applies: the plan of the parent whose birthday falls earlier in the calendar year is primary.

Some secondary policies may include a “non-duplication of benefits” clause. This clause means the secondary plan will not pay any amount if the primary plan’s payment equals or exceeds what the secondary plan would have paid had it been primary. In such cases, having a secondary plan might not provide additional financial benefit for certain procedures, even if the primary plan did not cover the full cost.

Finding and Evaluating Secondary Dental Insurance

Individuals seeking secondary dental insurance have several avenues to explore. If both spouses or partners have employer-provided dental benefits, one plan can often be designated as primary and the other as secondary. Alternatively, individuals can directly purchase a secondary policy from insurance companies or through private insurance marketplaces.

When evaluating potential secondary dental plans, several factors require careful consideration. Premiums, the monthly or annual cost, are a primary concern, as maintaining two policies increases overall expenses. Deductibles, the amount paid out-of-pocket before benefits begin, also need consideration.

Assess the annual maximums of both plans, which is the total amount the insurer will pay within a 12-month period. Understanding waiting periods is important; while preventive care often has no waiting period, basic procedures might have a 3- to 6-month wait, and major services often require a 6- to 12-month waiting period before coverage applies.

Examine the coverage levels for different procedure categories. Carefully comparing these elements against the primary plan’s benefits and anticipated dental needs helps determine if a secondary policy offers worthwhile value and aligns with personal financial planning goals.