Can I Have More Than One Dental Insurance?

Dental insurance helps manage the expenses associated with maintaining oral health. These plans typically cover a range of services, from preventive care like routine cleanings to basic restorative care such as fillings, and even major procedures including crowns. Many individuals question whether they can hold more than one dental insurance policy simultaneously, often due to various life circumstances or employment situations.

Holding More Than One Dental Plan

Individuals can generally maintain more than one dental insurance policy concurrently, a situation often referred to as dual dental coverage. This often occurs when someone is covered by their own employer’s plan and also as a dependent under a spouse’s employer-sponsored plan. Another common scenario involves an individual holding two jobs, each providing dental benefits. While permissible, multiple plans do not double benefits. Instead, they work together through a specific process called Coordination of Benefits (COB) to ensure total reimbursement does not exceed the actual cost of treatment.

Coordination of Benefits

When a patient has more than one dental plan, the process by which these plans work together to pay for services is called Coordination of Benefits (COB). COB prevents overpayment or duplication of benefits, ensuring combined payments do not exceed 100% of the service cost. One plan is designated as the “primary” insurer, which pays first, and the other as the “secondary” insurer, which may then cover remaining costs.

Determining which plan is primary typically follows specific rules. For dependent children covered by both parents’ plans, the “birthday rule” is commonly applied: the plan of the parent whose birthday falls earlier in the calendar year is usually primary. For individuals, the plan in which they are enrolled as the employee or main policyholder is generally primary over a plan where they are a dependent. If an individual has coverage through multiple employers, the plan that has covered the patient the longest typically serves as the primary.

After the primary plan processes the claim, the secondary plan reviews the remaining balance. It may then cover additional costs up to its limits, but the total combined payment will not exceed the allowed charge. For example, if a procedure costs $100 and the primary plan covers $80, the secondary plan may pay the remaining $20, resulting in no out-of-pocket cost.

Impact on Out-of-Pocket Costs

Having multiple dental plans, operating under Coordination of Benefits, can directly influence a policyholder’s personal financial responsibility. The primary effect is often a reduction in out-of-pocket expenses, such as deductibles, co-payments, and coinsurance. The secondary plan typically helps to cover these remaining costs after the primary plan has processed the claim, potentially minimizing the patient’s financial contribution.

While a secondary plan can significantly reduce personal costs, it does not mean receiving double payments or exceeding the actual cost of the dental treatment. The combined benefits from both plans are limited to the total allowed charges for the service.

Key Factors When Considering Additional Coverage

When evaluating or managing multiple dental insurance plans, several factors warrant careful consideration. Each plan has its own annual maximum, the total amount the insurer will pay for covered services within a specific period. Understanding these limits is important, as combined benefits will not exceed the total allowed charges. Some plans also impose waiting periods for certain procedures, meaning coverage will not begin until a specified time has passed after enrollment.

• Differences in covered services are common, with one plan potentially covering orthodontics while another might not, or varying percentages for basic versus major care. It is important to review the specific coverage details of each policy.
• The premiums for each policy contribute to the overall cost of maintaining dual coverage, which should be weighed against potential savings on dental procedures. Ensure the added cost justifies the potential benefits.
• Deductibles and co-payments can differ between plans and impact immediate out-of-pocket expenses. Understanding these upfront costs is crucial.
• Checking whether dental providers are in-network for both plans can affect the level of coverage and out-of-pocket spending. Out-of-network care may result in higher costs.