Can You Get Secondary Dental Insurance?

It is possible to have secondary dental insurance, often called dual coverage or supplemental dental insurance. This arrangement can be beneficial for individuals seeking to maximize their dental benefits and reduce out-of-pocket expenses. Understanding how two plans interact can help in navigating dental care costs effectively. This article will explore the mechanics of primary and secondary dental insurance, reasons for seeking additional coverage, and how these plans coordinate benefits.

Understanding Primary and Secondary Dental Insurance

When an individual is covered by more than one dental insurance policy, these policies are designated as primary and secondary. The primary dental insurance plan pays first for dental services. This is the plan through which an individual is enrolled as the main policyholder or employee. For example, if you have dental insurance through your job, that plan is your primary coverage.

The secondary dental insurance plan pays after the primary plan has processed its benefits. This plan acts as a supplemental layer of coverage, helping to cover remaining costs or procedures not fully addressed by the primary plan. The designation of a plan as primary or secondary is not based on which plan was acquired first, but on specific rules known as Coordination of Benefits (COB) principles. These rules dictate the order of payment when multiple plans are in effect, ensuring claims are processed efficiently and preventing overpayment.

Reasons for Seeking Secondary Dental Coverage

Individuals often seek secondary dental coverage to address financial gaps or limitations in their primary dental plan. One common reason is the high cost of extensive dental care, where a single plan’s annual maximums or coverage percentages may prove insufficient. Many primary plans have annual limits, often ranging from $1,000 to $1,500, which can be quickly exhausted by major procedures like crowns, bridges, or orthodontics. A secondary plan can help manage these expenses by covering a portion of the remaining balance after the primary plan has paid its share.

Another motivation for obtaining secondary coverage stems from limited benefits on a primary plan. This includes situations where the primary plan has high deductibles, covers only a small percentage of certain procedures, or excludes specific treatments such as orthodontics or major restorative work. Secondary insurance can expand the scope of covered services, potentially including procedures the primary plan does not cover. If a primary plan has a restrictive network of dentists, a secondary plan might offer access to a broader network, allowing individuals to choose preferred dentists or specialists. This added flexibility can help reduce overall out-of-pocket costs.

Coordination of Benefits Principles

Coordination of Benefits (COB) is the process insurance companies use to determine how multiple dental plans work together to pay for services. This system ensures that combined payments from all plans do not exceed the total cost of the dental treatment. When a claim is submitted, it is first sent to the primary insurer.

Once the primary insurer processes the claim and provides its Explanation of Benefits (EOB), outlining what it has paid, the remaining balance is then submitted to the secondary insurer along with a copy of the primary EOB. The secondary plan then reviews the claim and the primary’s payment, covering any unpaid balance for eligible services up to its own limits. The secondary plan will not pay for amounts already covered by the primary plan or exceed 100% of the allowed charges for the service.

Many secondary plans include a “non-duplication of benefits” clause. This provision means the secondary plan may not pay any additional amount if the primary plan has already paid as much as, or more than, what the secondary plan would have paid had it been the primary coverage. This clause can result in higher out-of-pocket costs for the patient compared to a standard coordination of benefits. For children covered by both parents’ plans, the “birthday rule” applies to determine primary coverage: the plan of the parent whose birthday falls earlier in the calendar year is considered primary. In cases of divorce or separation, a court order specifying insurance responsibility can override the birthday rule.

Finding and Enrolling in Secondary Dental Plans

Acquiring secondary dental insurance involves understanding available sources and evaluating plan details. One common way to obtain secondary coverage is through employer-sponsored plans, particularly if both spouses have access to dental benefits through their respective employers. In such scenarios, one spouse’s plan can serve as primary, and the other’s as secondary.

Individuals can also purchase secondary plans directly from insurance companies, similar to acquiring primary coverage. Various insurers offer individual dental plans designed to complement existing coverage. When considering a secondary plan, review the details of your existing primary plan, including its deductibles, annual maximums, and covered procedures. Researching potential secondary plans should involve examining their annual maximums, deductibles, and the percentage of coverage for different types of procedures, such as preventive, basic, and major care. It is also advisable to inquire about any waiting periods for specific procedures and to understand the secondary plan’s coordination of benefits rules, especially regarding non-duplication clauses. The application process requires personal information and details about any existing dental coverage.