Even the best insurance plans don’t cover everything. In the US, over 47% of Medicare beneficiaries don’t get dental coverage. A secondary dental insurance plan, whether obtained through choice or circumstance, can reduce your costs substantially. However, using a second policy wisely is complicated and requires a basic understanding of the administrative side of insurance.
You may end up with two dental plans for a variety of reasons, for example, if both spouses have family coverage from their employers.
A second policy can be advantageous, getting around a waiting period and reducing your out-of-pocket expenses.
With two policies, one is primary and is responsible for a larger part of the coverage.
A specific set of guidelines will determine which policy is primary, frequently depending on the age of the policy.
A complex process called coordination of benefits determines how much each insurance company has to contribute.
A second policy may not affect preventive services, which are frequently wholly covered by one policy.
Dual coverage is another way of describing secondary insurance.
When you receive dental benefits from two different insurance companies, one dental insurance plan is secondary. Primary and secondary dental plans aren’t necessarily two different types of dental insurance policies. Instead, it describes a somewhat technical distinction when it comes time for a dentist’s office to send a bill.
Imagine your family goes for their routine cleanings while everyone is covered by both you and your spouse’s dental plans. Preventive dental care like cleanings is usually fully covered, but which insurance company foots the bill? In this case, the birthday rule, which we’ll discuss later, determines which is primary and which is the secondary dental plan. The primary policy pays a larger amount, with several factors deciding the specifics.
There are a few different reasons you might end up with a secondary dental plan in addition to your existing dental plan:
When you have two policies, insurance claims go through a process called coordination of benefits, in which the different payment responsibilities are determined.
As secondary dental insurance plans are often the same as primary plans, there may not be a difference in covered services. However, there may be a difference in terms of waiting periods, premiums, and even the customer service of each insurance company. Dental care may not change, but administrative factors are significant enough to impact your out-of-pocket costs.
Preventive services like oral exams and basic care are often completely covered. However, major dental work may require a waiting period before it’s covered. As a result, it may make sense to keep dental plans from both former and current employers when you change jobs.
If you’re expecting your kids to need braces within the calendar year waiting period, you could face a long wait before insurance will contribute to the expense.
On the other hand, understanding a few basics can help you use secondary coverage wisely and save money on both basic care and major dental work.
Two dental insurance plans may seem like too much of a good thing, particularly when paying two premiums every month. However, it’s possible that having two policies can save you money. There are a few reasons extra coverage can be a good idea:
One thing to keep in mind is that the second insurance company may not have to contribute to the cost of dental services, depending on the specifics of the situation.
Generally, determining which insurance is primary is not something you, as the patient, have to worry about. There is a set of guidelines that dental care providers follow to figure out which policy is primary depending on a few factors. However, it can be helpful in estimating costs and deciding coverage to understand some common situations.
|Context||Primary and Secondary Insurance|
|Married couple, both having coverage through their employer||The patient’s plan is primary|
|One policy is through employer, the other is a private policy||The plan through the employer is primary|
|Coverage from both full and part-time jobs||Coverage through full-time employer is primary|
|Young adults covered by both employer and parent’s dental insurance plans||Longest plan in effect is primary|
|Child with coverage through both parents||The birthday rule: the policy of the parent whose birthday is first in the calendar year is primary|
|Child, with one plan being ACA embedded plan||ACA embedded plan is primary|
|Other contexts||In most cases, the older plan is primary, though the birthday rule is a good guideline for a child’s coverage |
Frequently, circumstances dictate the dental insurance plan that you end up with, either through an employer or through the Marketplace. However, you may also opt for supplemental dental insurance products, just because of the potential advantages they offer. The guidelines for choosing the best secondary policy are the same as choosing the best dental insurance overall, with a couple of edits:
Once it’s determined which plan is primary, the insurance companies and providers of dental care services work out how much each policy pays, adding another layer of complexity . At this point, it may not be a bad idea to seek out a licensed agent who can help. However, as before, there are some basic options it can help to know:
Coordination of benefits can be very complex.
Medicare doesn’t have a dental insurance offering as part of the basic plan, though it is available through an upgrade to Medicare Advantage . As a result, the dental insurance you get when covered by Medicare is sometimes called supplemental insurance, even though you don’t have two dental policies.
The only type of dental insurance available with the basic services of Medicare is emergency care. By design, Medicare focuses on medical coverage. That makes you wholly responsible for even routine cleanings and other preventive care which would be entirely covered under normal dental insurance.
For some folks on Medicare, even basic dental insurance may be beyond their means. However, there are some discount plans it may be worth investigating. They can allow some degree of dental care while keeping costs within reason. An example includes some offerings by Spirit Dental, which also feature insurance with no waiting periods.
Another option is Delta Dental, which is a national network of non-profit dental insurance providers. While those plans may include a waiting period, they are also quite affordable.
The only way to know for sure if a secondary policy is worth it is to break out the calculator and make some estimates. Before you do that, though, it can help to break down the advantages and disadvantages and see how they fit your specific situation.
Dual dental coverage doesn’t refer to separate types of dental insurance. It’s just another way of talking about secondary dental insurance. When you have a second dental plan that will provide coverage, then you have dual coverage. All the points we’ve already covered regarding any waiting period, cost of preventive care services, major dental care, and so forth still apply .
Since dual coverage is just another term for having secondary dental benefits, it works just as we’ve already discussed. However, a quick step-by-step review might help clarify a fairly complex topic. While there’s a lot more to it, using secondary insurance can be broken down into three steps:
Here are some simple answers to common questions on secondary dental insurance.
You can certainly get a secondary dental plan if you like. In fact, you could get a third or a fourth dental plan, as there’s no legal limit. It can be advantageous, as you may not have to deal with long waiting periods before major procedures and some other services are covered. On the other hand, preventive services may not be affected and there are no guarantees a waiting period will work to your advantage.
It’s actually pretty complicated. The primary plan is decided, often though not always determined by the effective date of coverage. The type of dental work and any waiting period are factored in, then a process called coordination of benefits determines how much each policy covers of the services you require.
The good news is that all of that is done by the insurance and provider, so you don’t have to worry about it.
There are a set of guidelines used to determine which dental policy is the primary. Frequently, the older policy is primary, though there isn’t a simple rule to figure that out.
The details of the plans make a difference. If one plan is primary, a major procedure may be covered by insurance with no waiting period. If the other ends up being primary, you may end up paying more for the same dental services.
Your insurance policy and company determine that, so checking with them may be the only way to know for sure what happens when you max out your dental coverage. Usually, it means that your policy will no longer contribute to expenses.
Maximums may not apply to basics like preventive care. However, treatment for gum disease or even oral surgery can run the total up quickly. A secondary plan may continue to contribute even if the primary plan is maxed. Also, note that some services may have separate maximums available after waiting periods.
The ultimate goal of dental health care is a beautiful healthy smile that lasts your whole life. However, between the waiting period for major procedures and cost of dental care, obtaining that smile can be expensive. Using secondary insurance is complicated, but may ultimately be worth it.