If I Have 2 Dental Insurances, Can I Use Both?

How Coordination of Benefits Works

Individuals with more than one dental insurance plan can often use both simultaneously through Coordination of Benefits (COB). This practice prevents policyholders from receiving more than 100% of service costs. COB ensures an orderly sequence of payments, reducing out-of-pocket expenses.

COB establishes which plan pays first for dental services. The primary plan processes benefits as if no other insurance exists, paying its portion of the claim according to its policy terms. After the primary plan has paid, the remaining balance may then be submitted to the secondary plan. The secondary plan reviews the claim and may cover additional eligible costs up to the total allowed amount. This approach ensures claims are processed efficiently and fairly.

Primary and Secondary Insurance Determination

Determining primary and secondary dental insurance is a structured process guided by specific rules, ensuring claims are paid correctly. A common guideline is the “Birthday Rule” for children covered by both parents’ plans. Under this rule, the parent whose birthday falls earlier in the calendar year typically has the primary insurance for the child.

When an individual has both an employer-sponsored and an individually purchased plan, the employer-sponsored plan is generally primary. A dental plan obtained through active employment usually takes precedence over COBRA or retiree benefits. For an individual covered by their own employer-sponsored plan and a spouse’s plan, their own plan is typically primary.

For government-sponsored programs like Medicaid or Medicare alongside private dental insurance, the private plan is often primary. However, interaction can vary based on the government program and private policy terms. Understanding these rules helps predict claim processing and ensures proper coordination.

Maximizing Your Benefits

To effectively utilize both dental insurance plans, it is important to inform your dental provider’s office about all active coverages at the time of your visit. Providing comprehensive insurance information upfront allows the office to properly file claims and coordinate benefits on your behalf. This initial step helps streamline the billing process and can prevent delays in payment.

The dental office typically submits the claim first to your primary insurance carrier. Once the primary insurer processes the claim, they send an Explanation of Benefits (EOB) detailing what they paid and what amounts remain. The dental office then usually forwards the claim, along with the primary EOB, to your secondary insurance for further consideration. This sequential processing allows the secondary plan to assess its contribution based on the remaining balance and its own policy terms.

Reviewing the Explanation of Benefits from both your primary and secondary plans is an important step to understand how your claims were processed. These documents detail the covered services, the amounts paid by each insurer, and any remaining patient responsibility. With two dental plans, it is often possible to significantly reduce or even eliminate out-of-pocket costs for covered services, depending on the specific benefit structures, deductibles, and annual maximums of each policy. For precise details regarding coordination of benefits rules and benefit limitations, directly contacting both insurance companies is advisable.