Is It Good to Have Double Dental Coverage?

Having two dental insurance plans simultaneously, often referred to as double dental coverage or dual coverage, means an individual is enrolled in more than one dental benefit program. This situation commonly arises when a person has dental benefits through their own employer and is also covered as a dependent under a spouse’s employer-sponsored plan. Another scenario involves an individual holding two jobs, both of which offer dental insurance benefits. While it might seem like having dual coverage could double benefits, the process is structured to coordinate payments between the plans rather than allowing for duplicate reimbursement.

Coordination of Benefits

When an individual has dual dental coverage, a process called Coordination of Benefits (COB) determines how the two plans work together to cover dental expenses. COB rules prevent overpayment, ensuring combined payments don’t exceed the service cost. One plan is primary, paying first; the other is secondary, covering the remaining balance. The secondary plan typically requires an Explanation of Benefits (EOB) from the primary insurer before processing a claim.

Primary plan determination depends on COB rules. Generally, the plan covering the individual as an employee or main policyholder is primary. For two jobs, the plan with the longest coverage duration is usually primary. For dependent children, the “birthday rule” often applies: the parent whose birthday falls earlier in the year has the primary plan, though court orders for divorced parents can override this rule. Only group (employer) plans typically coordinate benefits, not individual plans.

Financial Implications of Multiple Plans

A secondary dental plan can significantly reduce out-of-pocket expenses by covering costs the primary plan doesn’t fully cover. This includes portions of deductibles, co-insurance, or charges exceeding the primary plan’s limit. If the primary plan covers 80% of a procedure, the secondary plan may cover part or all of the remaining 20%, lowering patient costs. This is beneficial for expensive procedures like crowns or root canals.

The financial benefit of dual coverage is reduced out-of-pocket costs minus additional premiums for the second plan. While a secondary plan extends coverage, it doesn’t eliminate all costs, and combined payments won’t exceed the dentist’s allowed charge. Some secondary plans have a “non-duplication of benefits” clause, meaning they won’t pay if the primary plan’s payment equals or exceeds what the secondary plan would have paid as primary. For those with minimal dental needs, the additional premium for a second plan might outweigh potential savings.

Coverage Scope and Limitations

Dual dental coverage can broaden covered services or increase coverage percentages. A secondary plan might cover services not fully reimbursed by the primary plan, or contribute to major restorative work. This helps if one plan offers limited coverage.

Limitations still apply with dual coverage. Waiting periods, set times before specific procedures are covered, may still apply to the secondary plan; preventive care often has no waiting period, but basic services like fillings might have a three to six-month waiting period, while major procedures like crowns or dentures could have waiting periods of six months to over a year. Some services may not be covered by either plan, or they might be subject to frequency limits, such as maximum cleanings per year, regardless of dual coverage. Dual coverage does not eliminate all policy exclusions or limitations.

Evaluating Your Dental Needs

To determine if dual dental coverage is suitable, assess your typical dental care needs. Consider if your dental care primarily involves routine check-ups or if you anticipate extensive work like orthodontics or major restorative procedures. Understanding the likelihood of costly treatments helps weigh additional coverage benefits.

Next, compare the total cost of premiums for both plans against potential out-of-pocket savings. Review both primary and potential secondary dental plans, noting deductibles, co-insurance percentages, annual maximums, and covered services. Considering how COB rules apply clarifies the financial advantage. This evaluation allows for an informed decision based on individual circumstances and projected dental needs.