Dental work is not exactly the most exciting thing to spend Hawaiian-vacation-caliber money on. When it comes to pricetag anxiety, expensive dental work is right up there with roof repair, plumbing work and taxes: All things we know are necessary, but hope we don't end up with an unexpected bill for today. Alas, that day comes for all of us. And that's when you want to know the ins and outs of how, exactly, your dental insurance works. Or dental insurance plans, plural, if you're covered by more than one plan at the same time. It can get confusing quickly in these cases, and you might find yourself wondering which insurance is considered primary, which is secondary, or what that even means. That's why we've answered six common questions about dental insurance, including details on primary and secondary insurance, to help you through the process.
6 Answers to Your Questions about How Dental Insurance Works
A: Definitely not. Just as health insurance plans in general vary widely, dental coverage also takes many forms. If you are in the process of shopping for a plan, you might want to find out more about the three main types: Health maintenance organization, preferred provider organization, and indemnity plans.
A: This happens! It's not uncommon for people to be covered by two or more dental plans at the same time. When this happens, you have a primary plan, a secondary plan, and to determine which plan pays out when, companies follow a process called coordination of benefits (COB).
A: It can happen when two spouses are each subscribed to their employer-provided dental healthcare plans but both plans also cover their spouse, when dependents are covered by both parents' dental plans, or if someone has coverage from government programs such as TRICARE (for active military) or Medicaid (which usually only includes coverage for children).
A: The plan that pays first is considered the primary plan. This is determined by COB, which is usually dictated by state and government regulations. Generally, the primary plan is the one in which the patient is the main policyholder. The secondary plan is the plan that the patient is covered as a dependent.
A: After the primary plan processes and pays a claim, the secondary plan will process the claim to see if they cover any of the remaining balance. Combined, the benefits should not exceed 100% of the total charges. In the case of children covered by both parents' plans, the primary and secondary details will be sorted according to state laws or, if applicable, any custody agreements that are in place.
This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to be a substitute for professional advice, diagnosis or treatment. Always seek the advice of your dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.