Can I Have Two Dental Insurances at the Same Time?

Dual dental coverage, having more than one dental insurance plan, can offer additional avenues for managing dental care costs. Understanding how these plans interact is important for patients seeking to maximize their benefits and reduce personal expenses.

Possibility of Dual Dental Coverage

Having two dental insurance plans at the same time is permissible and occurs in various common situations. For instance, an individual might have dental benefits through their own employer and also be covered as a dependent under a spouse’s employer-sponsored plan. Another scenario involves an individual holding two jobs, each providing its own dental coverage. Additionally, someone might supplement an employer-provided plan with a privately purchased dental policy.

While dual coverage is allowed, it does not mean that benefits are automatically doubled. Dental insurance companies employ specific rules to prevent overpayment and ensure that the total reimbursement for services does not exceed the actual cost of care.

How Coordination of Benefits Works

When an individual has dual dental coverage, the interaction between the two plans is governed by a process called Coordination of Benefits (COB). COB is a set of rules used by insurance companies to determine which plan pays first (the primary plan) and which plan pays second (the secondary plan).

The determination of which plan is primary typically follows a structured hierarchy. Generally, the plan covering the individual as a policyholder or employee is considered primary. If someone has two plans from their own employment, the plan that has been in effect for the longest period is usually designated as the primary insurer. The plan under which the individual is covered as a dependent, such as through a spouse’s policy, would then serve as the secondary plan.

For dependent children covered by both parents’ dental plans, the “birthday rule” often dictates primary coverage. Under this rule, the plan of the parent whose birthday falls earlier in the calendar year (month and day, not year) is considered primary. However, if parents are divorced or separated, a court decree specifying responsibility for dental expenses can override the birthday rule. It is important to note that only group (employer-sponsored) plans are required to coordinate benefits; individual plans may not have COB provisions with other plans.

Once the primary and secondary plans are determined, the claim submission process begins. The dental provider first submits the claim to the primary insurance carrier. After the primary insurer processes the claim and pays its portion, they will issue an Explanation of Benefits (EOB) document. This EOB details what the primary plan covered and any remaining balance.

The dental provider then submits the remaining balance to the secondary insurance plan, along with a copy of the primary plan’s EOB. The secondary plan reviews the claim and the primary plan’s payment. It then pays any additional benefits according to its own coverage limits and terms.

Financial Aspects of Dual Coverage

Dual dental coverage can significantly impact a patient’s out-of-pocket expenses. When both plans coordinate benefits, the secondary plan can help cover costs that the primary plan did not, potentially reducing the patient’s financial responsibility for deductibles, copayments, and coinsurance. With dual coverage, some secondary plans may waive their deductible if the primary plan’s deductible has already been met.

Similarly, annual maximums, which represent the total amount a dental plan will pay for a member’s care within a specific period, can be extended with dual coverage. If the primary plan’s annual maximum is reached, the secondary plan may then contribute to remaining costs, providing additional financial protection for extensive dental work.

However, dual coverage does not guarantee that 100% of all dental expenses will be covered. Many plans include a “non-duplication of benefits” clause. This provision states that if the primary plan paid an amount equal to or greater than what the secondary plan would have paid had it been primary, the secondary plan may not pay any additional benefits. Therefore, while dual coverage can lead to substantial savings, it is designed to cover the actual cost of treatment, not to allow a patient to profit from claims. Patients also continue to be responsible for premiums associated with each plan.