Can I Have 2 Dental Insurance Plans?
Learn how having two dental insurance plans works, from eligibility to how it affects your dental expenses.
Dental insurance is designed to help manage the costs associated with maintaining oral health, covering a range of services from routine cleanings to more extensive procedures. Many individuals find themselves wondering if they can have more than one dental insurance plan to further reduce their out-of-pocket expenses. This is a common situation, and understanding how multiple plans interact is beneficial for maximizing coverage.
Eligibility for Multiple Dental Plans
Having two dental insurance plans, often referred to as dual dental coverage, is generally permissible. This situation typically arises from specific life circumstances, rather than individuals intentionally purchasing multiple policies. For instance, you might have dental coverage through your own employer and also be covered as a dependent under your spouse’s employer-sponsored plan.
Another common scenario involves individuals working two jobs, where both employers offer dental benefits. Maintaining an individual dental plan while also being covered by an employer’s plan can also result in dual coverage. While having dual coverage is allowed, it does not mean your benefits will double. Insurance companies have established procedures to manage claims when multiple policies are involved.
Understanding Coordination of Benefits
When an individual is covered by more than one dental plan, insurance companies use a standard industry practice called Coordination of Benefits (COB). This process determines which plan pays first, known as the primary plan, and which plan pays second, referred to as the secondary plan. COB prevents overpayment and ensures that the combined benefits from all plans do not exceed 100% of the total allowed charges.
Determining which plan is primary and secondary follows specific rules. If you have coverage through your employer and are also covered under a spouse’s plan, your own employer’s plan is primary. For dependent children covered by both parents’ plans, the “birthday rule” applies; the plan of the parent whose birthday falls earlier in the calendar year is primary. Exceptions exist, such as court orders in cases of divorced parents, which can supersede the birthday rule.
Once the primary plan processes a claim and pays its portion, an explanation of benefits (EOB) is issued. The secondary plan then reviews the remaining balance to determine its payment responsibility. This approach ensures that both plans contribute according to their terms without duplicating benefits.
Impact on Dental Costs
Having two dental insurance plans can significantly reduce your out-of-pocket expenses for covered dental services. After the primary plan pays its portion, the secondary plan can cover some or all of the remaining balance, leading to lower costs for the patient. This arrangement benefits more expensive procedures like crowns, root canals, or implants.
Deductibles are handled in a coordinated manner; the primary plan’s deductible must be met before it begins to pay. The secondary plan may then waive its own deductible or contribute to the remaining costs. While each plan has its own annual maximum, the combined payout from both plans will not exceed the actual cost of treatment. The secondary plan may contribute up to its own maximum after the primary plan has paid.
Dual coverage can also provide broader coverage for different types of services. For example, if your primary plan covers routine cleanings but not orthodontics, a secondary plan might cover the latter, filling gaps in coverage. This often results in a lower patient co-pay compared to having only one plan.