Is It Worth Having Two Dental Insurances?

Many people have access to more than one dental insurance plan, whether through a spouse’s employer, a second job, or a personal policy. This situation, known as dual coverage, often leads to questions about its benefits. This article explores dual dental insurance to help you decide if it suits your dental care needs and financial goals.

Understanding Coordination of Benefits

Coordination of Benefits (COB) is the process that dictates how two dental plans work together to pay for claims. COB prevents overpayment by ensuring the combined benefits from both plans do not exceed the total cost of services. It establishes a clear hierarchy, designating one plan as “primary” and the other as “secondary.”

The primary plan generally covers the individual as an employee or main policyholder. For dependent children, the “Birthday Rule” typically determines the primary plan: the parent whose birthday falls earliest in the calendar year (month and day) is usually primary. After the primary plan processes the claim and pays its portion, the secondary plan may then cover remaining costs up to its limits. However, some COB clauses, such as “non-duplication of benefits,” mean the secondary plan might not pay if the primary plan’s payment equals or exceeds what the secondary plan would have paid on its own.

Analyzing the Financial Implications

Understanding the financial implications is crucial for determining if dual dental coverage is beneficial. Premiums for two plans accumulate, and these combined costs must be weighed against potential savings on dental work. While dual coverage aims to reduce out-of-pocket expenses, it rarely results in 100% coverage or eliminates all costs.

Deductibles are often handled so you only need to meet the primary plan’s deductible. The secondary plan might waive its deductible if the primary has paid a certain amount. Copayments and coinsurance also benefit from dual coverage, as the secondary plan can reduce the patient’s out-of-pocket share after the primary plan has paid.

However, annual maximums for each plan are not combined into a single, larger maximum. Once a plan’s annual maximum is reached, that specific plan will not pay further benefits until the next period. Dual coverage can effectively extend the total amount of coverage received by utilizing the annual maximums of both plans.

Specific Situations for Dual Coverage

Dual dental coverage is advantageous when anticipated dental needs are significant. For instance, individuals requiring extensive restorative work, such as multiple crowns, bridges, or root canals, may find combined coverage beneficial. High-cost procedures like dental implants or orthodontics, which often involve substantial out-of-pocket expenses even with a single plan, are also situations where dual coverage can lead to lower patient costs.

Dual coverage is also valuable when one plan has a low annual maximum easily met by routine or moderate procedures. The secondary plan can then provide additional coverage for remaining costs. Similarly, if one plan has high deductibles or high coinsurance percentages for specific services, the secondary plan can help mitigate these costs.

Submitting Claims with Two Insurances

Submitting claims with two dental insurance plans follows a structured approach. First, the claim is submitted to the primary insurance provider. This plan processes the claim according to its benefits and then issues an Explanation of Benefits (EOB). The EOB details the services received, the amount charged, the amount covered by the primary insurance, and any remaining balance.

Once the primary insurance has processed the claim and the EOB is received, any remaining balance is then submitted to the secondary insurance. Often, a copy of the primary EOB is required by the secondary insurer to facilitate their processing. Many dental offices are experienced in managing coordination of benefits and can handle claim submission to both plans on behalf of the patient, streamlining the process.