Dental insurance is essential for many people to help cover the cost of dental care. However, sometimes, people have more than one dental insurance plan, which is known as double coverage. If you’re wondering how double coverage dental insurance works and how it affects your dental care costs, this article will explain it in simple terms.
What is Double Coverage Dental Insurance?
Double coverage occurs when a person has two dental insurance policies. This can happen in several ways, such as when both spouses have dental insurance through their respective employers or when someone is covered by a parent’s insurance policy while also having their own. Double coverage helps provide additional coverage, but how it works may seem complicated.
How Does Double Coverage Work?
In simple terms, double coverage means that two insurance plans will share the cost of dental care. Each plan may cover a percentage of your dental expenses, but the total amount covered by both plans cannot exceed the total cost of your dental treatment.
Coordination of Benefits
When you have double coverage, the two insurance companies will coordinate benefits to determine who pays what portion of the bill. The coordination process ensures that one insurance policy pays first (the primary insurance), and the second policy pays afterward (the secondary insurance). The order of the insurance policies is essential to make sure the payments are made properly.
Primary vs. Secondary Insurance
The primary insurance plan pays first. It covers the costs according to the terms of the policy, such as deductibles, co-pays, and coverage limits. The secondary insurance plan pays second, covering the remaining costs after the primary insurance has made its payment.
For example, if your primary insurance covers 70% of a dental procedure, and your secondary insurance covers 20%, the two insurance plans will cover 90% of your dental bill. You will be responsible for paying the remaining 10%.
Why Do People Have Double Coverage?
There are several reasons why someone might have double coverage dental insurance:
1. Multiple Insurance Policies Through Employers
Many people have access to dental insurance through their employer and their spouse’s employer. This often happens when both spouses work and offer dental insurance benefits. Having two dental plans can give extra coverage and help reduce out-of-pocket expenses.
2. Coverage for Children
In some cases, a child might be covered by both parents’ dental insurance policies. This ensures that the child has additional coverage, which can help reduce costs for dental procedures, especially if the child requires frequent visits to the dentist.
3. Better Coverage for High-Cost Procedures
Having double coverage can be particularly beneficial if you require expensive dental work, such as crowns, bridges, or orthodontic treatments. Double coverage can help make these procedures more affordable by covering more of the costs.
How to Maximize the Benefits of Double Coverage
To make the most of having two dental insurance plans, it is essential to understand how to maximize the benefits. Here are a few tips:
1. Know the Order of Your Plans
The first step is to understand which insurance is considered primary and which is secondary. This order depends on the specific details of the insurance policies. For example, if you’re a dependent on your spouse’s plan, their plan will likely be considered primary, and your own plan will be secondary.
2. Check Both Policies for Coverage Details
Different dental insurance policies offer different coverage levels for treatments. For instance, one plan might offer better coverage for preventive care, while the other may offer more coverage for restorative work. Check the benefits of both policies to understand what is covered and how much they pay.
3. Understand Deductibles and Coverage Limits
Each policy may have different deductibles and annual coverage limits. The deductible is the amount you must pay out of pocket before your insurance begins covering costs. Be sure to factor in both deductibles when planning for dental treatments, as both plans may apply different deductibles for each service.
4. Make Sure Both Insurances Are Accepted by Your Dentist
Before going for a procedure, confirm that your dentist accepts both your primary and secondary insurance policies. Some dental providers may only work with specific insurance companies, so it’s essential to confirm this in advance.
Double Coverage Dental Insurance and Its Benefits
Having double coverage can provide several advantages. Let’s take a closer look at some of the benefits:
1. Reduced Out-of-Pocket Costs
The most significant benefit of double coverage is that it can help reduce your out-of-pocket costs. With two insurance plans covering your dental care, you may not need to pay as much for procedures, checkups, or treatments.
2. Higher Coverage for Expensive Dental Procedures
Expensive dental procedures, such as root canals, crowns, or dental implants, can be costly. Double coverage can help you cover a more significant portion of the cost, meaning less out-of-pocket expense.
3. Broader Access to Care
With double coverage, you may have access to a wider network of dental providers, as different insurance companies may have different networks. This can give you more choices when selecting a dentist or specialist.
Potential Drawbacks of Double Coverage
While there are clear benefits to having double coverage, it’s essential to be aware of potential drawbacks as well:
1. Confusing Claim Process
The process of coordinating benefits between two insurance companies can sometimes be confusing and time-consuming. Each company may have different rules and requirements for filing claims, leading to potential delays in payments or confusion about which plan covers what portion of the bill.
2. Not All Expenses Are Covered
Double coverage doesn’t mean all your dental expenses will be fully covered. You may still have co-pays, deductibles, and expenses that are not covered under either plan. Additionally, the secondary plan may not cover everything that the primary plan doesn’t pay for.
3. Limited Payouts
Even with two insurance policies, the total amount paid out by both plans is typically limited to the cost of the dental treatment. Insurance companies will not pay more than what the dental service costs. For example, if the procedure costs $500 and the primary plan covers $350, the secondary plan may cover the remaining $150, but no more.
4. Higher Premiums
Having double coverage may increase your overall premium costs. Depending on your situation, paying for two insurance policies could be more expensive than having just one plan.
Steps to Take When Filing Claims with Double Coverage
To ensure the claims process goes smoothly, it’s crucial to follow these steps when filing claims with double coverage dental insurance:
1. File with the Primary Insurance First
When you visit the dentist, provide the details of your primary insurance plan first. The primary insurance will pay a portion of the bill according to its coverage terms.
2. File with the Secondary Insurance
Once the primary insurance has made its payment, file the remaining balance with the secondary insurance. You’ll need to provide a copy of the explanation of benefits (EOB) from the primary insurer, which outlines what was paid.
3. Understand Each Plan’s Coordination of Benefits Rules
Different insurance companies have different rules about how they handle double coverage. Be sure to read the fine print of your policies to understand how they handle coordination of benefits and what you need to do to ensure all claims are processed correctly.
Conclusion
Double coverage dental insurance can be an excellent way to reduce your out-of-pocket costs and access more comprehensive dental care. By understanding how it works, including the coordination of benefits and the roles of primary and secondary insurance, you can maximize your coverage and minimize your expenses. However, it’s essential to weigh the benefits against the potential drawbacks, such as the complexity of filing claims and the possible increase in premiums. With careful planning, double coverage can be a smart way to ensure that you get the dental care you need without breaking the bank.
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