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How Does Secondary Dental Insurance Work

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Disadvantages Of Dual Coverage Dental Insurance

How Does Supplemental Dental Insurance Work? : Dental & Other Insurance Questions

There are a few potential downsides to dual dental coverage:

  • If youre covered by two or more dental plans, you may be paying for redundant coverage.
  • If your dental plan has a non-duplication of benefits clause, the secondary plan will not pay any benefits if the primary plan paid the same or more than what the secondary plan allows.
  • If you dont let your dental office know that you have dual coverage, they may not submit your dental claim correctly. Knowing which plan is primary or secondary ensures that claims are processed correctly and quickly. If a claim is processed in the wrong order, the claim could be delayed or reversed and adjusted. When this happens, you might be on the hook for any remaining balance.

What Is The Best Supplemental Dental Insurance For You

The best supplemental dental insurance plan is the one that fits the needs of you, your family, and your budget.

If you have a primary dental insurance plan through your or your partners employer, review the coverage to identify any gaps or services that you think you will need that are not covered. Are there waiting periods? Are the deductibles and copays high, meaning you will have to pay a lot out of your own pocket? Does the plan have restrictions such as no coverage to replace pre-existing missing teeth or no orthodontic coverage?

If your children or you want to get braces, the best supplemental dental insurance plan may be one that has orthodontic coverage. If you are missing several teeth and want to have them replaced but your primary plan doesnt cover for pre-existing conditions, you likely need to find a supplemental plan that provides a benefit regardless of when the teeth were pulled.

Perhaps you have a great medical insurance plan, but it does not include any provisions for dental care. The supplemental dental insurance plan that may work for you will be one that has comprehensive coverage to address yours and your family needs.

What Is Supplemental Dental Insurance

Medical or health insurance rarely covers dental treatment except for emergency care such as dental treatment that is needed after a car wreck or other type of accident. Traditional Medicare, the federal insurance program for senior citizens, does not offer any dental coverage.¹

Supplemental dental insurance is available to help pay for dental treatment. Whether you have an employer-sponsored health or dental plan, an individual plan, or are a senior citizen covered by Medicare, you can purchase supplemental dental insurance directly from an insurance company, through a broker, or on the Affordable Care Acts marketplace.

Having a supplemental dental insurance plan in addition to your medical coverage helps you to get regular dental care from a dentist. Regular dental check-ups help to prevent serious dental conditions from occurring, which are expensive to treat.

A supplemental dental insurance plan can also support your existing dental plan if its benefits are not sufficient to cover the dental care needs of you and your family.

Another advantage of having a supplemental dental insurance plan is to provide benefits for services that your current plan may not cover, called restrictions or exclusions. For example, if your current plan does not cover adult braces , you can find a supplemental plan that specifically covers braces for adults. You can typically use the supplemental plan, in conjunction with your primary dental insurance, to help pay for your orthodontic care.

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Establishing Primary And Secondary Plans

The plan that covers you through your employer is considered your primary plan. If you are also covered under your spouse or domestic partner’s policy, that plan is considered secondary coverage. If you have coverage through two jobs, the coverage held the longest is the primary plan. If one plan is through current employment and the other through a retiree plan, the current employer is primary.

Can You Have Two Health Insurance Plans

How Does Secondary Dental Insurance Work

Yes, you can have two health plans.

The most common example of carrying two health insurance plans is Medicare recipients, who also have a supplemental health insurance policy, says David Mordo, former national legislative chair and current regional vice president for the National Association of Health Underwriters.

Its also possible that a married couple could have two health insurance plans, even if each spouse is covered through a health insurance plan at their workplace.

Theyre both covered under their own policies with their companies, but one of the spouses decides to jump on their spouses plan, Mordo says.

You also might have two health insurance plans if you have health insurance but also receive Medicaid coverage. Or, perhaps you are under the age of 26 and have group coverage both through an employer and your parents health insurance.

Other examples of when you might have two insurance plans include:

  • An injured worker who qualifies for workers compensation but also has his or her own insurance coverage.
  • A military veteran who is covered by both Veterans Administration benefits and his or her own health plan.
  • An active member of the military who is covered both by military coverage and his or her own health insurance.

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What Is A Dental Savings Plan

A dental savings plan, also referred to as a dental discount plan, isn’t health insurance. Instead, it’s a benefit program that allows you to take advantage of savings and discounts when paying for dental care. Similar discount programs cover health care services beyond dental care.

Rather than paying premiums as you would with health or dental insurance, you pay a membership fee to join a dental savings plan. This fee is typically less than $150 per year for a family.

Each time you visit the dentist, you show the health care provider your savings card to receive a discount on eligible dental care services.

The terms of a dental savings plan, what’s covered, and the amount of discount you may be eligible for can vary greatly, depending on the plan. For example, services may be grouped into one of three categories:

  • Preventive treatments, such as cleanings and dental exams
  • Basic treatments, such as fillings, extractions, and X-rays
  • Major treatments, such as implants or orthodontia

Dental savings plans can be offered by insurers as an alternative to dental insurance. Humana, for example, offers a Dental Savings Plus Plan that offers 20% to 40% paid coverage on preventive care services, with discounted fees for basic and major care services obtained through an in-network provider.

  • Doesnt cover 100% of the cost of any service

  • Limits on whom you can seek care from

Coordinating Dental Insurance Benefits

Whether youre using supplemental insurance, a second dental insurance policy, or a dental savings plan you should be aware of how your primary plan has any policies about coordinating benefits. This information can usually be found in your plans policy documents. If you cant locate the information, speak with your dentist or the members service team at your insurance providers member service team.

Rules about benefits coordination can vary, so it is critical to get the specific details about your plan from your healthcare provider or insurance company frankly, you may want to get the information from both. If youre on Medicare, you can just call the Benefits Coordination & Recovery Center at 1-855-798-2627.

Basically, coordination of benefits comes down to deciding which insurance plan is the primary payer which plan pays first. Just to make things more complicated, the payer who pays first isnt the first one to pay its the insurance company that is responsible for paying the bill up to the limits of your coverage. Anything remaining goes to the second payer, and perhaps even a third.

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Can You Get Secondary Health Insurance For A Child

Yes, you can also purchase additional health insurance plans for children including hospital indemnity, gap health insurance, vision insurance and more.

Children can also have multiple health insurance plans because they’re covered by both of their parents’ plans. One of the insurance plans will be considered primary, and the other will be secondary.

Coordinating benefits usually uses the “birthday rule.” The parent whose birthday falls first in the calendar year would provide the child’s primary insurance policy, and the other parent’s plan would be the child’s secondary insurance plan, contributing to any remaining health care costs after the first policy is used.

How Dental Insurance Categorizes And Pays For Procedures

How does Dental Insurance work?

Dental procedures covered by insurance policies are typically grouped into three categories of coverage: preventive, basic, and major. Most dental plans cover 100% of preventive care, such as annual or semiannual office visits for cleaning, X-rays, and sealants.

Basic procedures are treatments for gum disease, extractions, fillings, and root canals, with deductibles, copays, and coinsurance determining the patients out-of-pocket expenses. Most policies cover 80% of these procedures, with patients paying the remainder. Major procedures such as crowns, bridges, inlays, and dentures are typically only covered at 50%, with the patient paying more out-of-pocket expenses than for other procedures.

Every policy differs in terms of which procedures are categorized as preventive, basic, and major, so it is important to understand what is covered when comparing policies. Some policies classify root canals as major procedures, while others treat them as basic procedures and cover much more of the cost.

Patients who may need costlier procedures should pay particular attention to the details of dental insurance policies. For instance, a single dental implant can cost $3,000 to $6,000. Many basic dental insurance plans don’t cover implants, and those that do come with limits and exclusions. With that in mind, many consumers choose dental insurance that will cover implants.

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How Does Secondary Dental Insurance Work

The most common scenario for secondary dental is for members who carry primary dental insurance through their employer. Members can then purchase secondary dental coverage in the private market to get access to additional benefits. Typically the plan youve had first will be considered primary and the newer plan would be secondary coverage.

Its important to keep in mind that most dental plans that are secondary will not make payments until the primary plan has exhausted its payment for a treatment. However for someone needing a larger amount of dental work, secondary coverage can make a lot of sense.

Do I Need Dual Coverage Or A Supplemental Dental Insurance Plan

There is nothing inherently right or wrong in having either dual coverage or a supplemental dental insurance plan. You must look at all the pros and cons and decide what is the best method of insuring you and your family against expensive dental treatment needs.

Dual coveragehaving two or more dental insurance policiescan offer financial benefits when you or a family member needs expensive dental treatment.

Supplemental policiesthose purchased specifically to cover dental treatment that is not included in a medical or other dental plan is a wise choice when other policies do not provide coverage for dental treatment you know you or a family member needs.

Having a dental insurance plan makes going to the dentist for routine and preventive care more likely. Good dental health helps the entire body to stay healthy. Whether you have one dental insurance plan or multiple policies, using your coverage to its fullest extent can pay off in overall good health and help reduced financial burdens.

This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist’s office.

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Can You Be Covered By Two Health Insurance Plans

Yes, you can be covered by two health insurance plans.

In some cases, each member of a couple might have health insurance through their employer. Children up to the age of 26 also might have coverage through their employer and their parents.

It is also possible for others such as members of the military and those who are on Medicare but are still working to have more than one form of coverage.

However, being covered by two plans is the exception to the rule. If youre covered by one solid employer-based health insurance plan, thats usually sufficient for most people, Mordo says.

Youre really not getting any benefit by being covered by two different employer-based plans, he says.

What Dental Services Fall Within Orthodontics

How Supplemental Dental Insurance Works

Its a good idea to understand the services that are typically associated with orthodontics before you evaluate your dental insurance options. According to the American Association of Orthodontists , an orthodontist provides procedures to fix teeth that result in conditions such as dental overbites, underbites, and crowded or misaligned teeth. These issues can be fixed by slowly applying pressure on specific teeth to coax them into place without surgery. Often orthodontic treatment involves the following services:

  • An initial evaluation, which may include x-rays of the jawand teeth, and treatment planning, as indicated
  • Tooth removal if needed to correct overcrowding
  • Routinely scheduled treatment visits
  • Orthodontic appliances, including braces and/or a retainer

Orthodontists design and fit appliances to realign teeth and jaws to produce and maintain normal function and to improve appearance. Among the most common orthodontic appliances are:

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Can You Get Dental Insurance Anytime

Yes. There is no open enrollment period like there is for health insurance. You can buy dental insurance any time of the year, and coverage typically starts within days of submitting your application.

Note: There may be a waiting period for major services, so its smart to review any dental plan youre interested in to confirm the waiting and coverage periods.

Primary Insurance Vs Secondary Insurance: Who Pays First

Coordination of benefits isnt always standard. Plans can differ, so its vital to talk to your employers benefits department and health plan if you have two health plans.

That said, here are situations when you may have more than one health plan and which one would likely be the primary insurer and which would be secondary:

Situation

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How Does Dental Insurance Work

Dental insurance can pay for things like annual cleanings, minor oral health fixes, or big-dollar dental claims for crowns and bridges. In general, dental coverage is broken out by preventive, basic and major services:

  • Preventive dental care includes diagnostic and preventive services like regular oral exams, teeth cleaning, and x-rays. It may also include fluoride treatments and sealants . In many cases, dental plans include 100% of the cost of preventive care.
  • Basic dental care includes office visits, extractions, fillings, periodontal treatment , and root canals. Your insurance company might pay anywhere from 60 to 80% of the cost for these services, with you covering the rest of the cost. But if you’re paying a lower percentage of the costs, you may have a high-dollar copay.
  • Major dental care covers crowns, bridges, dentures, and inlays. Inlays are something between a filling and a crown: Your tooth might have extensive decay and need a more substantial filling, but it may not be in bad enough shape to require a crown. Meanwhile, crowns completely cover the tooth. Some dental insurance plans include root canals under “major” dental care, while others categorize them as “basic.” The cost of major dental care is higher, and most insurance plans cover about 50% of the fee.

There are two main types of dentail insurance plans:

Vision Plan: A Window Into Your Overall Health

What Dual Coverage in Dental Insurance Means

Vision plans usually cover routine eye exams and help cover prescription lenses and frames. And like dental care, eye exams can also detect early signs of overall health problems, such as high blood pressure and lupus. Thats why its smart to see an eye doctor if even if you have 20/20 vision.

Cecilia, 27, is single and living in Miami, FL. The copy editor at a local magazine has worn prescription glasses since she was a young girl. She wants to update to a more stylish frame this year and knows that her vision plan gives her an annual frame allowance, as well as a reduction in the cost of prescription lenses. If she wanted to try out contacts, she could use her lens benefits for those instead. Either way, Cecilia will be looking her best and protecting her vision for the long term.

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Should I Consider Secondary Health Insurance Coverage

Some people think in terms of primary insurance vs. secondary insurance. But the two types of insurance can complement one another.

For example, Mordo says Medicare beneficiaries can benefit from having both Medicare and a supplemental policy.

There are great advantages to that because the supplemental policy picks up whatever Part A and Part B does not cover, he says. That is a huge savings on potential out-of-pocket cost for a Medicare beneficiary who might be on a fixed income.

Its also true that dual health plans can reduce your health care costs if the secondary insurance picks up some medical costs that your primary plan doesnt cover.

However, Mordo believes the downsides of having two health insurance policies usually outweigh any benefits.

The disadvantage is the outlay in additional premiums, he says. Youre paying for two plans, and the benefit is minuscule.

Other downsides to having two health plans include:

Dental Insurance Covers Some Services At 100%but Not Everything

Dental insurance covers a portion of your dental care costs. You pay a monthly premium and often a deductible. In return, plans cover you for preventive care such as dental exams and cleanings, at zero cost.

Once you meet a deductible, your plan may cover restorative services, such as fillings for cavities, tooth extractions, root canals, crowns, bridges, and dentures. But it usually wont cover 100 percent of the costs for these. Youll probably still have coinsurance, which means youll be expected to pay a percentage of the dentists charges as well.

Most dental plans also have annual maximums for each plan year. So, if your annual maximum is $2,000 and your dental expenses are $3,000, youre responsible for the additional $1,000.

There are two main ways you can get dental insurance:

  • Through your employer. Many employers offer dental coverage as part of their employment benefits. You can apply for it during your companys annual open enrollment.
  • Purchasing private dental insurance. If your employer doesnt offer dental coverage, you can buy a separate, stand-alone dental plan from a private insurance company.

To find a plan that meets your needs and budget, talk to one of our HealthMarkets agents. Call .

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