Can You Have Two Dental Insurance Policies?

Dental insurance plays an important role in managing oral health costs, and many seek coverage to minimize out-of-pocket expenses. Understanding dental insurance, including the possibility of holding more than one policy, helps in making informed decisions for dental care. While dental plans can seem complex, grasping core concepts like eligibility and benefit coordination simplifies the process.

Eligibility for Multiple Policies

Individuals can hold two dental insurance policies simultaneously, known as dual dental coverage. This often arises when covered by one’s own employer plan and a spouse’s plan. Individuals may also supplement an employer plan with a separate, purchased policy. Dependent children may also be included in both parents’ plans. While having multiple policies is permissible, it does not mean benefits are automatically doubled.

Understanding Coordination of Benefits

When a patient has more than one dental plan, Coordination of Benefits (COB) determines how plans share service costs. COB rules prevent “over-insurance” or benefit duplication, ensuring total payment does not exceed 100% of the service cost. One plan is primary, paying first, and the other is secondary, covering remaining eligible costs. The primary plan processes the claim first; the secondary plan then requires an Explanation of Benefits (EOB) from the primary before processing its portion.

Determining which plan is primary depends on several factors. For adults, the plan where the individual is the main policyholder is primary; any dependent plan is secondary. If an individual has two employer plans, the one covering them longest is primary. For dependent children, the “birthday rule” applies: the parent whose birthday falls earlier in the calendar year (month and day) has the primary plan, regardless of birth year. Exceptions can occur with court orders for divorced or separated parents, which may specify primary coverage.

Some dental plans include a “non-duplication of benefits” clause, impacting the secondary plan’s payment. If the primary plan pays an amount equal to or greater than what the secondary plan would have paid as primary, the secondary plan may not make additional payment. This provision is common in self-funded plans and can result in higher out-of-pocket expenses. Generally, only group or employer-sponsored plans are required to coordinate benefits; individual policies may not.

Evaluating a Second Policy

Before acquiring or maintaining a second dental policy, evaluate its financial implications and alignment with individual dental needs. Weigh the combined premium cost against potential increased coverage or reduced out-of-pocket expenses. While dual coverage can help reduce overall costs, it does not guarantee that all dental expenses will be fully covered. Understanding how deductibles, annual maximums, and waiting periods interact between policies is important.

Most dental plans include an annual maximum, the total dollar amount the plan pays for covered services within a 12-month calendar year, typically $1,000 to $2,000. Deductibles, the amount an individual pays before insurance covers costs, also apply to each plan. Waiting periods, ranging from a few months to over a year, may apply to specific services like basic or major dental work, even if preventive care is covered immediately. A second policy might help cover costs once the primary plan’s annual maximum is reached, or provide coverage for services not included in the primary plan. However, thoroughly review each policy’s COB clause, including any non-duplication provisions, to understand the actual benefit from dual coverage.