Can You Double Up on Dental Insurance?

Dental insurance helps manage dental care costs, from routine check-ups to extensive procedures. It covers a portion of these expenses, reducing out-of-pocket burdens. Many wonder if they can hold more than one dental insurance plan simultaneously. It is permissible to have multiple dental plans, which influences how services are paid for.

Possibility of Multiple Dental Plans

Individuals can be covered by more than one dental insurance plan. This is often called dual dental coverage and is common. For instance, an individual might have one dental plan through their own employer and another through a spouse’s employer, or they could supplement an employer-provided plan with a privately purchased policy.

While having two plans is allowed, it does not mean that all dental costs will be fully covered or that benefits will double. Instead, a specific process determines how each plan contributes to treatment costs. This arrangement aims to provide broader coverage and reduce personal expenses.

Coordination of Benefits

When an individual has multiple dental plans, Coordination of Benefits (COB) governs the payment process. COB ensures plans work together to cover expenses without overpaying or duplicating benefits. Its goal is to ensure total payments do not exceed the dental procedure’s cost.

COB rules establish which plan is primary and which is secondary. The primary plan pays its benefits first, as if no other coverage exists. After the primary plan has paid its portion, the secondary plan may cover remaining eligible costs, up to its own limits.

Common rules for determining the primary plan include the plan covering the patient as an employee or main policyholder, which is primary over a plan where the patient is a dependent. For dependent children, the “birthday rule” often applies; the parent whose birthday falls earlier in the year has the primary plan. In instances of divorced or separated parents, a court decree specifying financial responsibility for healthcare expenses takes precedence over the birthday rule.

Claim Processing with Multiple Plans

Claim processing with multiple dental plans begins when a patient receives treatment. The dental office submits the claim first to the primary insurance carrier. The primary insurer then processes the claim and pays its determined portion based on the policy’s terms, including deductibles and co-insurance.

Once the primary plan processes the claim and issues an Explanation of Benefits (EOB), any remaining balance is submitted to the secondary plan. The secondary insurer reviews the EOB from the primary plan and applies its own policy rules, including any deductibles, co-insurance, and annual maximums. The secondary plan then pays any additional amount it covers, reducing the patient’s out-of-pocket expenses. This sequential payment process ensures that combined payments from both plans do not exceed the total allowed charge, preventing overpayment.

Considerations for Multiple Plans

Several factors warrant consideration when evaluating multiple dental insurance plans. Weigh the cost of premiums for two plans against potential reductions in out-of-pocket expenses like deductibles, co-payments, and co-insurance. While dual coverage can significantly lower personal costs for extensive or costly dental procedures, the expense of two sets of premiums might outweigh the savings for individuals who only require routine preventive care.

Annual maximums from both plans can interact, potentially offering a higher combined coverage limit for substantial dental work. Understand how each plan’s annual maximum applies and whether the secondary plan’s benefits are truly additive. Managing two plans also involves administrative aspects, such as understanding coverage details, waiting periods, and limitations of each policy. Review policy documents for coordination of benefits clauses, as these can vary and impact financial outcomes.