Is Dual Dental Coverage Worth It for You?

Dental insurance helps manage the costs of dental care by covering a percentage of treatment expenses, with the policyholder paying the remainder. These plans often include coverage for preventive services, basic procedures, and major treatments, each reimbursed at different rates. Many individuals receive dental insurance through their employer, but individual plans are also available.

Dual dental coverage means an individual is enrolled in two separate dental plans simultaneously. While this might seem to imply double benefits, the reality is more nuanced, as these plans interact in specific ways to determine coverage. Understanding how these multiple plans function together is important for making informed decisions about dental care and associated costs.

Understanding Dual Dental Coverage

Dual dental coverage occurs when an individual is enrolled in two different dental insurance plans simultaneously. This commonly arises when covered by one’s own employer plan and as a dependent under a spouse’s plan, or when holding two jobs that each provide benefits.

Dual coverage does not mean receiving double benefits. Instead, the two plans work together to determine contributions through specific rules known as Coordination of Benefits (COB). COB rules prevent overpayment, ensuring the total paid by both plans does not exceed the service cost. These guidelines manage how claims are processed and costs are distributed.

How Coordination of Benefits Works

Coordination of Benefits (COB) determines which plan pays first and how much each plan covers with dual dental coverage. The primary plan pays its benefits first, and the secondary plan then considers the remaining balance. This process ensures the combined payment from both plans does not exceed the service cost.

Several rules determine the primary plan. If an individual has coverage through their own employer and a spouse’s employer, their own employer’s plan is primary. For dependent children, the “birthday rule” applies: the plan of the parent whose birthday falls earlier in the calendar year is primary. If an individual has more than one employer plan, the plan that has covered the patient longest is generally primary. Only group (employer) plans are typically required to coordinate benefits; individual plans generally do not.

After the primary plan pays, the secondary plan evaluates the remaining cost based on its COB method. One common method is “non-duplication of benefits.” Under this rule, if the primary plan paid as much or more than the secondary would have, the secondary may not pay further. Another method is the “carve-out” approach, where the secondary plan calculates its payment, then reduces it by what the primary plan already paid.

Deciding If Dual Coverage is Right for You

Deciding if dual dental coverage is beneficial requires evaluating individual financial circumstances and anticipated dental needs. Weigh the added cost of premiums for a second plan against potential out-of-pocket savings. Premiums vary, but comparing them with expected benefits from both plans is essential.

Understand the deductibles and annual maximums of both plans. A deductible is the amount paid out-of-pocket before coverage begins. Some preventive services, like routine cleanings, often do not require meeting a deductible. An annual maximum is the total dollar amount a dental plan will pay for covered services within a benefit period. Once this maximum is reached, the patient is responsible for additional costs until the next plan year.

Assess personal and family dental health. For routine needs like cleanings, a second plan’s benefits might be minimal, as primary plans often cover preventive care. However, for anticipated major procedures like root canals, crowns, or orthodontics, dual coverage could substantially reduce out-of-pocket expenses. Dual coverage is most advantageous when combined benefits significantly lower financial responsibility for expensive treatments, outweighing additional premium costs.

Managing Dual Coverage Claims

Understanding the claims process is important for efficient benefit utilization with dual dental coverage. When dental services are rendered, the dental provider typically submits the claim to the primary insurance plan first. This plan processes the claim and pays its portion of the covered services.

After the primary plan processes the claim and issues an Explanation of Benefits (EOB), the remaining balance is submitted to the secondary dental plan. The EOB is a statement from the primary insurer detailing the services received, the amount covered by that plan, and any remaining patient responsibility. The secondary plan requires a copy of this EOB to determine its payment.

For smooth claim processing, provide both insurance cards to the dental office at the time of service. Verifying coverage with both plans beforehand can help clarify which plan is primary and understand the estimated patient responsibility. Keeping detailed records of treatments, payments, and EOBs from both insurers is also a good practice for tracking benefits and resolving any discrepancies.