Can You Use More Than One Dental Insurance?

Dental insurance helps manage the costs associated with maintaining oral health, covering a portion of preventative, basic, and major dental care services. Many individuals rely on these plans to make dental treatments more affordable and accessible. Many wonder if having multiple dental insurance policies is permissible or beneficial. Understanding how these plans interact is important for optimizing dental care expenses.

Using Multiple Dental Insurance Plans

It is generally possible for an individual to be covered by more than one dental insurance plan. This situation often arises when someone has coverage through their own employer and also through a spouse’s or parent’s employer. When multiple plans are in effect, the standard industry practice known as Coordination of Benefits (COB) governs how these plans work together. The primary purpose of COB is to ensure that the total benefits paid by all plans do not exceed 100% of the actual cost of the dental services received.

How Coordination of Benefits Functions

Coordination of Benefits (COB) establishes a structured process for multiple dental plans to pay claims, preventing overpayment. One plan is designated as the primary payer, which processes the claim first according to its own benefit schedule, deductibles, and annual maximums. The secondary plan then reviews the remaining balance after the primary plan has paid its portion. Typically, an individual’s own employer-sponsored plan is considered primary, followed by a spouse’s plan, and then a parent’s plan for a dependent child.

COB includes a non-duplication of benefits clause, ensuring total reimbursement from all plans does not exceed the eligible charges for the service. This prevents individuals from profiting from their dental claims. Insurance companies utilize different methods for coordination, but the combined payout does not exceed 100% of the allowed charge.

The interplay of multiple plans under COB also affects deductibles and annual maximums. Once the primary plan processes the claim, the secondary plan may apply its own deductible if it has one, or it might waive it if the primary plan’s deductible was met. Each plan maintains its own annual maximum benefit, but combined payments will not surpass the total cost of services.

Maximizing Your Dental Benefits

Having a secondary dental insurance plan can significantly reduce or even eliminate out-of-pocket expenses for covered services. After the primary plan processes a claim and pays its portion, the secondary plan may cover the remaining balance, including co-pays, co-insurance, or portions of the deductible. This can lead to substantial savings for the policyholder, as the financial responsibility for dental procedures is spread across two insurers.

For instance, if a primary plan covers 80% of a service, the secondary plan might cover the remaining 20%, up to its allowed amount, leaving little to no cost for the patient. This expanded coverage can make more extensive or specialized dental treatments financially feasible. It also means that services might be covered at a higher percentage or up to a greater combined annual limit than with a single plan.

Navigating Claims with Multiple Plans

When seeking dental care with multiple insurance plans, it is important to inform your dental office about all active coverages. Providing comprehensive information allows the administrative staff to properly process your claims. You should be prepared to furnish policy numbers, group numbers, and the subscriber’s name for each plan to ensure accurate billing.

Typically, the dental office will submit the claim electronically to the designated primary insurance carrier first. Once the primary insurer processes the claim and issues an Explanation of Benefits (EOB) detailing their payment, the dental office then often submits the remaining balance to the secondary insurance carrier. In some instances, depending on the dental office’s policies or the insurance companies’ procedures, you might receive the EOB from the primary plan and then need to submit the claim to your secondary insurer yourself. It is advisable to review all EOBs received from both insurance companies to understand how the charges were covered and to verify any remaining patient responsibility.