Understanding Dual Dental Insurance Coverage

It could be said that limits on dental insurance plans are “vintage”: The general model hasn’t been updated since the 1970s, plus many health insurance plans don’t include dental coverage, and the Affordable Care Act (ACA) considers dental coverage essential for children – but not adults.

Most existing plans offer maximum annual limits of $500 to $1,500, and although that may have been adequate in the 1970s, now a couple of fillings or one root canal will likely max out one’s benefits. As a result, many go without much-needed dental care.

Dual coverage

There is a solution to this dilemma. Think “dual coverage.” But while it is possible to have two dental policies, there are restrictions around carrying two plans.

If you have dual coverage, you’ll have a primary plan and a secondary plan. The two insurers work together – known as “coordination of benefits” – to determine which is which, and which policy will pay for what. The general rule is that employer-sponsored coverage is the primary plan, and other plans – such as those bought privately or through a spouse’s employer or a retirement plan – would be secondary. The primary plan may also be the plan you’ve held for the longest time.

How dual coverage works

Assume each plan covers 80 percent of two cleanings annually. The two policies wouldn’t pay for four cleanings annually. Your primary plan pays first. Your secondary policy would be supplementary to the primary.

In the case of non-duplication clauses – which are standard in most policies – secondary policies only pay if the primary plan doesn’t pay up to the primary plan’s allowed amount.

For example, the primary plan will often cover 80 percent of services, while you have a co-pay 20 percent. But if, for some reason, the primary plan only pays 70 percent, the secondary policy would pay the 10 percent difference after you’ve paid the 20 percent co-pay amount.