Can You Carry Two Dental Insurance Plans?

Many individuals wonder if they can hold more than one dental insurance plan. Understanding how multiple plans interact and the considerations involved is important for managing healthcare costs. This article explores dual dental coverage, detailing how plans coordinate payments and factors to consider.

Possibility of Multiple Dental Plans

Individuals can be covered by two or more dental insurance plans. This arrangement is often referred to as dual dental coverage. Common situations include having dental benefits through one’s employer and as a dependent under a spouse’s plan, or holding two jobs that both provide dental benefits.

While dual coverage is possible, benefits are not automatically doubled. Instead, the plans work together to determine how claims are paid, ensuring that the total reimbursement does not exceed the cost of the dental procedure. Understanding this is important before delving into how claims are processed with multiple plans.

How Plans Coordinate Payments

When an individual has dual dental coverage, the process of determining which plan pays first and how much each plan contributes is governed by “Coordination of Benefits” (COB) rules. COB is an industry standard that prevents overpayment and ensures efficient claim processing when multiple insurers are involved. Under COB, one dental plan is designated as the primary payer, and the other becomes the secondary payer. The primary plan processes the claim first according to its own benefit schedule.

The determination of primary versus secondary coverage follows specific guidelines. Generally, the plan covering the individual as an employee or main policyholder is considered primary. If an individual has coverage through two employers, the plan that has provided coverage for the longest period is typically deemed primary. For dependent children covered by both parents’ plans, the “birthday rule” usually applies, making the plan of the parent whose birthday falls earlier in the calendar year the primary one, irrespective of the birth year.

After the primary plan processes the claim and pays its portion, an Explanation of Benefits (EOB) document is issued. This EOB details the services received, the amount charged, the amount covered by the primary insurer, and any remaining balance. The remaining balance, along with the primary plan’s EOB, is then submitted to the secondary plan for consideration. The secondary plan will then review the claim and may pay up to its allowed amount, taking into account what the primary plan has already paid. Some plans may also include a non-duplication of benefits clause, which can limit or prevent the secondary plan from paying if the primary plan’s payment meets or exceeds what the secondary plan would have paid as primary.

Evaluating Dual Coverage

When considering dual dental coverage, individuals should assess financial and administrative factors. Compare the cost of premiums for both plans against potential reductions in out-of-pocket expenses. While dual coverage can lower costs for extensive dental work, the additional premiums for two plans might outweigh the savings if dental needs are minimal.

Review each plan’s terms, including deductibles, annual maximums, and waiting periods. A deductible is the amount an individual must pay before the insurance begins to cover costs, and this typically resets annually. Annual maximums, which typically range from $1,000 to $2,000, represent the total amount a dental insurance plan will pay in a given benefit year. Waiting periods, which can range from a few months to over a year for basic or major procedures, dictate how long an individual must wait after enrollment before certain services are covered. Understanding these elements helps in determining how the plans might complement each other.

Individuals should also consider the administrative effort involved in managing two plans, including submitting claims to both. While dental providers often handle claim submissions, understanding the documentation required, such as the primary plan’s EOB, is beneficial. Ultimately, the decision to maintain dual coverage should align with one’s anticipated dental needs and financial situation, after understanding how the plans coordinate benefits.