Secondary Dental Insurance: All You Need to Know in [2022]

Secondary Dental Insurance: A Complicated Way to Save Money

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.

 

Key Takeaways

  • 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.

 

What Is Secondary Dental 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:

Reasons why you may end up with secondary dental insurance

 

  • Both spouses are covered by each others’ plans.
  • Overlap between prior coverage and current dental insurance plan.
  • Gap dental insurance policies.
  • Coverage from both full and part-time jobs.
  • Young adults covered by both employer and parent’s dental insurance plans.
  • Choosing dual coverage.

 

When you have two policies, insurance claims go through a process called coordination of benefits, in which the different payment responsibilities are determined.

 

What Does Supplemental Dental Insurance Cover?

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.

 

Why Get Secondary Dental Insurance?

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:

Reasons to get a secondary dental insurance

 

  • Dental insurance waiting period: Waiting periods vary between policies and one policy could be older. Keeping double coverage may help save money on timely major dental work, or allow full insurance with no waiting.
  • Basic and major services: Frequently, a dental insurance plan covers all or most of basic dental care like exams or x-rays. They may cover less of procedures like root canals or crowns, however, which extra insurance can help pay for.
  • In-network providers: Two policies may give access to a wider range of dental care services, allowing you to work with both networks.
  • Annual maximums: A second policy can help prevent reaching your max, and cover you even if you do. It can also help defray the costs of certain treatments that may have separate maximums.

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.

 

What Is the Difference Between Primary and Secondary Dental Insurance?

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 [1]

How To Pick the Best Supplemental Dental Insurance for You

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:

  • Understand the different types of insurance plans: Not all insurance plans operate the same way, so understanding the difference between PPO and HMO plans can be key.
  • Evaluate your needs: What are your situation and needs? If you’re getting a second plan, you might be expecting some steep dental expenses, so coordinating waiting periods and other aspects can save you money.
  • Consider costs and budget: The goal is affordable coverage for dental care, so do the math and add up your premium costs, understand each waiting period, and work out how much you’ll end up paying for major dental work.
  • Understand the basics of coordination of benefits: The secondary plan may not always have to contribute and the size of their contribution can vary. That’s decided in the coordination of benefits process.

 

Coordination of Benefits

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 [2]. 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:

  • Traditional Split: The beneficiary of the policy can receive anything up to the full benefits of both policies, potentially covering 100% of expenses.
  • Maintenance of Benefits: The primary policy pays its normal share. The secondary plan applies normal deductible and copay requirements, which you still have to cover, then pays any remaining.
  • Carve Out: The normal benefits are calculated as a cap. The primary pays what is required by that policy. Any additional coverage, up to the previously calculated cap, is then paid by the secondary insurance.
  • Nonduplication: The secondary plan covers what the primary does not. If they cover the same things, the secondary plan doesn’t pay anything [3].

Coordination of benefits can be very complex.

 

Medicare Supplemental Dental Insurance

Medicare doesn’t have a dental insurance offering as part of the basic plan, though it is available through an upgrade to Medicare Advantage [4]. 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.

 

Pros and Cons of Having Secondary Dental Insurance

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.

 

Advantages of secondary Dental Insurance

  • Possible dental savings.
  • Could mean a shorter waiting period for major services.
  • More of a covered service may get paid for.
  • Wider network of dentists.
  • Differences in the waiting periods can work to your advantage.
  • Retain coverage even if you reach annual maximums.

Disadvantages of secondary Dental Insurance

  • Very complicated.
  • Probably won’t affect coverage of basic services.
  • Waiting periods may not work to your advantage.
  • Could end up costing you more.
  • Secondary insurance may not always have to contribute.

 

What Is Dual Dental Coverage?

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 [5].

 

How Does Dual Coverage Work?

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:

 

  1. Obtain secondary insurance: You end up with two dental plans, either by planning or circumstance. You decide to take advantage of things like different waiting period times, more coverage for expensive procedures and major services, and a wider choice of providers.
  2. Determine primary insurer: Once you use your benefits, the insurance companies decide which is the primary insurer, responsible for covering the large part of dental care and services.
  3. Coordination of benefits: The two insurers decide how much they each contribute to coverage.

 

FAQ

Here are some simple answers to common questions on secondary dental insurance.

 

Can You Get a Secondary Dental Insurance Plan?

How Does It Work If You Have Two Dental Insurance Plans?

What Determines Primary and Secondary Insurance?

What Happens When You Max Out Your Dental Insurance?

 

Conclusion

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.

 

References:

  1. Association, California Dental. “Dental Benefit Plan Handbook – Chapter 04: Understanding Coordination of Benefits.” CDA, CDA, 3 June 2021, https://www.cda.org/Home/Resource-Library/Resources/category/coordination-of-benefits/dental-benefit-plan-handbook-chapter-04-understanding-coordination-of-benefits.
  2. “Coordination of Benefits.” CMS, 1 Dec. 2021, https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Coordination-of-Benefits/Coordination-of-Benefits.
  3. “ADA Guidance on Coordination of Benefits.” American Dental Association, https://www.ada.org/resources/practice/dental-insurance/ada-guidance-on-coordination-of-benefits.
  4. “Understanding Dental Benefits.” Understanding Dental Benefits - WhyDental.org, https://community.nadp.org/whydentalorg/about/understanding-dental-benefits.
  5. “Understanding Coordination of Benefits and Dual Coverage.” Scripps.edu, July 2009, https://www.scripps.edu/hr/benefits/forms/Dental_Understanding_Coordination_of_Benefits_and_Dual_Coverage.pdf.

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