Having multiple plans doesn’t guarantee extra benefits, but it doesn’t necessarily make you worse off, either. You don’t even have to go out and decide to purchase more than one plan on your own. There’s more than one way to be in this situation, and what you’ll get out of having both is based on that situation.
First, we’re going to look at assumptions about what having at least two dental plans is like, then dig into the reality to show how those assumptions contrast with the outcomes.
This will be analyzed from the perspective of having two dental insurance policies for simplicity.
When looking through a dental insurance policy, you’ll see that while it does cover a lot, it also has limitations. Dental insurance won’t give you full coverage unless you’re getting an x-ray or cleaning, or any other preventive service.
Dental insurance policies only agree to cover you up to a certain amount – usually between $1,000 and $2,000. You’re paying out-of-pocket after that until the next year comes.
On paper, two plans together seem like a great way to fully circumvent coverage limitations. It just takes buying multiple policies on your own, and then you never pay for anything out-of-pocket again. Unfortunately, that’s not the reality.
These Determine How This Will Actually Work
Where you get your policies has the biggest influence on how they’ll work together. That’s why you must get the details about how your policy will work with another before enrolling because there is a worst-case scenario that we’ll discuss in a moment.
Aside from yourself, you may get your second policy from:
- Your employer(s)
- Your spouse’s dental insurance plan
When you’ve got your two dental insurance policies:
- They will work together based on a Coordination of Benefits (COB)
- You will have designated primary and secondary policies
- Primary pays everything it can at first
- Secondary pays what it can of the remainder
- Primary insurance is decided by whatever policy you’ve had longer
- Primary insurance may also be decided on which the membership is in your name (applies if you’re covered by your spouse’s insurance plan; in this case, the one you have individually or through your employer will be the primary insurer)
At Worst, Your Secondary Insurer Doesn’t Pay Anything
This is categorized as non-duplication coordination of benefits – the worst outcome if you want something from your secondary insurer. Normally, state laws make it so there is at least some benefit to having two policies, which will apply to the other scenarios that will be listed.
Non-duplication coordination of benefits mainly applies to plans where the insurance plan’s sponsor assumes the utilization risk.
This is the one situation where state laws don’t apply. The only coverage you’ll get here is from your primary insurance. Because you don’t receive a benefit from this secondary insurance, there is no benefit to having it.
The Carve-Out Coordination of Benefits
The carve-out coordination of benefits is where the resulting secondary insurance and out-of-pocket amounts are determined by subtracting (or “carving out”) what the primary paid.
The Secondary Insurance Helps Lower Copays
This is the maintenance of benefits. Here, your copayments are discounted but your out-of-pocket cost reduction is not to the extent of the next form of coordination of benefits.
Your Two Dental Insurance Plans Add Up to Give You Up to 100% Coverage
This is the traditional coordination of benefits. This is the simplest process – your primary covers what it can of the bill, then the secondary insurance covers all that it can for the cost remaining.
Expertise Makes the Difference
Without professional help, you’re much more likely to fall into the trap of having multiple insurance plans that don’t work together. That, or you’ll spend hours meticulously combing through the finer details of any insurance policy that looks good on the surface.
But we do this work every day. We’re trained professionals with a keen eye for how plans work together, and how they should work together. Our job exists to help you enroll in policies that don’t backfire.
We are Trusted Senior Specialists. We not only take pride in ourselves and the work we do but the people we help take pride in us. We can help you find a dental insurance policy that works for you. Make that next step today by calling (855) 952-1941. You can also schedule a video chat appointment with us for free.