Can You Use Two Dental Insurances for Braces?

The cost of dental care, especially for orthodontic treatments like braces, can be substantial. Many individuals use dental insurance to manage these expenses. Dual coverage, having two dental plans, can significantly help cover the costs associated with braces.

Understanding Dual Dental Coverage

Dual dental coverage means having two active dental insurance plans. This often occurs when an individual is covered by their own employer’s plan and a spouse’s plan, or by two jobs. While it might seem to offer double benefits, plans work together to cover costs.

Coordination of Benefits (COB) dictates how two dental plans interact to prevent overpayment and ensure benefits do not exceed 100% of covered charges. COB rules establish the order in which plans pay for services.

Under COB, one plan is primary, and the other is secondary. The primary plan pays first. Generally, the plan covering the patient as an employee is primary over a dependent plan. For children, the “birthday rule” often applies, making the parent’s plan whose birthday falls earlier in the year primary.

After the primary insurer pays its portion, the secondary plan considers the remaining balance. The secondary plan may cover additional costs, up to its limits. The total combined payment from both plans will not exceed the total allowed amount for the service.

How Dual Coverage Works for Braces

Orthodontic coverage often has limitations different from general dental care. Many plans include age limits, typically covering dependents under 18, and most have lifetime maximums instead of annual maximums. Waiting periods may also apply before benefits become active.

When dual coverage applies to braces, COB ensures both plans contribute without duplicating payments. The primary plan processes the claim first, paying its portion based on coverage percentage and lifetime maximums. For instance, if braces cost $5,000 and the primary plan covers 50% up to a $2,000 lifetime maximum, it would pay $2,000.

The remaining balance, $3,000 in this example, is then submitted to the secondary insurance. The secondary plan reviews the claim, considering the amount already paid. If the secondary plan covers 25% and has a lifetime maximum, it might pay an additional $750, bringing the total insurance payment to $2,750. The patient would be responsible for the remaining $2,250.

Lifetime maximums are important in dual coverage for orthodontics. Once a plan’s lifetime maximum is reached, it will no longer contribute. Some secondary plans may have a “non-duplication of benefits” clause, meaning they won’t pay if the primary plan paid as much as or more than the secondary plan would have.

Steps for Using Two Dental Plans

To use two dental plans for braces, first gather information from both insurance providers. Contact each insurer to understand their COB rules, orthodontic benefits, lifetime maximums, waiting periods, and claim submission procedures.

Inform the orthodontist’s office about both plans before treatment. Provide both insurance cards and policy numbers initially to ensure accurate billing. This communication helps the office manage claim submission efficiently.

Most orthodontist offices handle dual coverage and submit claims to both primary and secondary companies. The office typically submits to the primary insurer first, waits for the Explanation of Benefits (EOB) and payment, then submits the balance to the secondary insurer. Patients may need to provide the primary plan’s EOB to the secondary insurer if the office doesn’t.

After claims are processed, review the EOBs from both insurance companies. These documents detail covered services, amounts paid by each insurer, any denials, and remaining financial responsibility. Understanding EOBs confirms correct benefit application and identifies outstanding patient responsibility.