Can I Have 2 Dental Plans?

Dental plans help manage the costs of oral health. They typically cover a portion of expenses for various dental services, from preventive to more involved procedures. Individuals often obtain plans through employers or purchase them directly from insurance providers. These plans reduce out-of-pocket expenses for services like routine cleanings, X-rays, and examinations. Many plans categorize services into preventive, basic, and major, often covering preventive care at 100%, and basic or major services at lower percentages like 80% or 50%.

Having Multiple Dental Plans

It is possible to be covered by two or more dental plans simultaneously, often called dual dental coverage. This commonly occurs when an individual has dental benefits through their employer and is also covered as a dependent under a spouse’s employer plan. Another frequent situation involves a person holding two jobs, both providing dental benefits. Some individuals might also combine an employer-sponsored plan with a privately purchased one to enhance coverage.

The primary motivation for a second dental plan is often to reduce out-of-pocket costs and gain access to a broader range of services. While dual coverage does not mean receiving double benefits, it can significantly lower financial responsibility for procedures. A secondary plan might help cover costs the primary plan does not, or provide additional assistance once the primary plan’s annual maximum benefit has been reached. This can be beneficial for expensive treatments like crowns, bridges, or orthodontics not fully covered by a single plan.

How Benefits Are Coordinated

When an individual has more than one dental plan, Coordination of Benefits (COB) determines how plans work together to cover costs. COB ensures the total amount paid by all plans does not exceed 100% of the dental service cost, preventing over-insurance or duplication of benefits. One plan is designated as “primary,” paying its benefits first, and the other is “secondary,” considering the remaining balance.

Determining the Primary Plan

Rules for determining which plan is primary vary by circumstance:
If a patient is covered as an employee under one plan and as a dependent under another, their employment plan is primary.
For individuals with coverage from more than one employer, the plan that has covered the patient longest is primary.
For children covered by both parents’ dental plans, the “birthday rule” applies: the plan of the parent whose birthday falls earlier in the calendar year is primary, regardless of birth year.
If parents are divorced or separated, a court order specifying responsibility for dental expenses takes precedence over the birthday rule.

After the primary plan processes the claim and pays its portion, an Explanation of Benefits (EOB) is sent to the secondary insurer. The secondary insurer then evaluates the remaining balance and pays according to its terms, up to its limits.

Deciding on Additional Coverage

Evaluating whether to obtain or maintain additional dental coverage involves a careful cost-benefit analysis. Compare the combined premium costs of both plans against potential savings on dental care expenses. For individuals with minimal dental needs, the added cost of a second premium might outweigh the benefits, as routine check-ups are often fully covered by a single plan.

For those anticipating significant dental work, such as major restorative procedures, increased coverage and reduced out-of-pocket costs from dual plans can offer substantial financial relief. Consider each plan’s features, including annual maximums, deductibles, and waiting periods.

Some secondary plans may have “non-duplication of benefits” clauses, which could limit their payment if the primary plan has already paid an amount equal to or greater than what the secondary plan would have paid if it were primary. It is advisable to directly contact both insurance providers to understand their Coordination of Benefits rules and any limitations on combined benefits. This helps ensure an informed decision that aligns with individual or family dental care needs and financial goals.