Can You Have More Than One Dental Insurance?

It is possible to have more than one dental insurance plan. Many individuals find themselves in situations where they could be covered by multiple plans, which can influence their financial responsibility for dental services. This dual coverage does not mean a duplication of benefits but rather a coordinated approach to payment.

Understanding Multiple Dental Plans

Individuals may be covered by multiple dental insurance plans through common scenarios. This often occurs when someone has benefits through their own employer and is also covered as a dependent on a spouse’s employer-sponsored plan. It can also happen if a person holds two jobs offering dental benefits, or if they have an employer-sponsored plan in addition to an individually purchased policy.

Dual dental coverage does not mean beneficiaries receive double benefits or double payment for the same service. Instead, these plans work together to determine how expenses are covered, aiming to reduce out-of-pocket costs. Dental discount plans are not insurance and do not coordinate benefits with insurance policies.

How Claims are Processed

When an individual has multiple dental insurance plans, the process for handling claims is governed by Coordination of Benefits (COB). COB rules determine the order in which each plan pays for dental services to prevent overpayment or duplicate benefits, ensuring that the combined payment from all plans does not exceed 100% of the total cost of the dental procedure. One plan is designated as the “primary” insurer, which pays first, and the other is the “secondary” insurer, which may cover remaining eligible costs.

The determination of which plan is primary and which is secondary follows specific rules. Generally, the plan covering the patient as an employee or main policyholder is considered primary. If an individual has coverage from two employers, the plan that has covered the patient for the longest duration is often the primary one. For dependent children covered by both parents’ plans, the “birthday rule” applies: the plan of the parent whose birthday falls earlier in the calendar year (month and day) is primary, regardless of the year of birth. Court orders in cases of divorce or separation can override the birthday rule.

Once the primary insurer processes and pays its portion of the claim, an Explanation of Benefits (EOB) statement is generated, detailing what was covered. This EOB is then submitted to the secondary insurer, which reviews the remaining balance and may cover additional eligible costs up to its own benefit limits or the total allowable amount for the service. This structured approach ensures that patients do not receive more than 100% of the cost of the service from the combined plans, aiming to reduce the patient’s out-of-pocket expenses.

Practical Considerations

Considering multiple dental insurance plans involves weighing various financial and practical factors. A primary consideration is the cost of premiums for each plan versus the potential reduction in out-of-pocket expenses. For individuals who primarily need routine preventive care, the added cost of a second premium might not always provide substantial additional financial benefit.

Annual maximums and deductibles are important features to understand with dual coverage. Most dental plans have an annual maximum, which is the total dollar amount the insurer will pay for services within a benefit period, typically $1,000 to $2,000 per person. Once this maximum is reached, the patient is responsible for 100% of further costs until the next plan year. Deductibles, typically around $50 per person, are the amounts a patient must pay before the insurance begins to cover costs. While a secondary plan might help cover a portion of the primary plan’s deductible or extend benefits beyond a single plan’s annual maximum, it is important to review how these apply across both policies.

Many dental plans also include waiting periods, particularly for basic or major procedures. These can range from a few months for basic services like fillings to 12 months or more for major work such as crowns or root canals. Preventive services often have no waiting period. If a new secondary plan has a waiting period, its benefits for certain procedures may not be immediately available. Individuals should also check if their preferred dentist is in-network for both plans, as network restrictions can impact coverage levels and out-of-pocket costs.

Effective utilization of multiple plans requires proactive communication. Informing both the dental office and the insurance companies about all active plans is important to ensure proper Coordination of Benefits and accurate claim processing. Reviewing the specific plan documents for each policy to understand their COB rules, coverage limits, and any exclusions is also highly recommended. This diligence helps individuals make informed decisions about whether maintaining multiple plans is financially advantageous for their specific dental care needs.