Supplemental dental insurance explained
Supplemental dental plans help fill in the gaps left by your medical plan or another dental insurance plan.
- Supplemental dental insurance can help you pay for dental treatment if you don’t have dental insurance from your employer
- A supplemental dental insurance plan can also support your existing dental plan if its benefits are not sufficient
A supplemental dental insurance plan may be needed if your health insurance does not cover any dental services or if the dental plan you have is insufficient to cover the dental care needs of you and your family. Supplemental dental insurance plans can step in to provide benefits or reimbursement for dental treatment when other plans fall short of your 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 Act’s (ACA) 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.
If your current dental insurance plan has a smaller annual maximum benefit, or limit on what the insurance will pay out annually, a supplemental plan can cover treatment that exceeds that cap. If you need expensive dental work, such as implants or bridges, the cost can typically exceed an annual limitation on benefits. Having a supplemental dental plan can help alleviate the financial burden by covering all or part of the charges that exceed the allowed maximum of your dental insurance plan.
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 (orthodontics), 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.
What does supplemental dental insurance cover?
If you have a dental insurance plan through your employer or have purchased an individual plan, that plan is known as your primary plan. Whenever you have any dental treatment done, you or your dental provider sends a claim to your primary plan. Depending on the details of the plan, the primary plan typically pays for all or part of the charges.
If the primary plan pays only a part of the charges, then your supplemental dental insurance plan can help cover either all or part of the remaining balance of your dental bill provided it is an approved dental service. Supplemental plans will not accept a claim until after the primary plan has paid the claim. This is known as coordination of benefits (COB).
For example, if you have a crown procedure that costs $1,000 and your primary insurance pays $500, you can submit a claim to your supplemental plan after the primary has finished paying. Depending on the benefits specified in your plan, the supplemental insurance may pay some or all the remaining $500 balance.
Dental insurance purchased as a supplemental plan typically provides specific amounts of coverage for a variety of dental services, similarly to a primary plan. It is important to understand the services covered—for example preventive, restorative, major, endodontics, surgery, orthodontics— and the amount of the benefits before signing up for a supplemental plan.
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 partner’s 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 doesn’t 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.
Supplemental dental insurance for Medicare
Senior citizens face unique challenges in seeking coverage for dental services. While Medicare may provide coverage for hospitalizations and most out-patient medical services, only certain Medicare plans provide benefits for dental care.²
If you’re on Medicare, you may not be receiving dental insurance benefits from a full-time employer. But that doesn’t mean you aren’t eligible to receive dental insurance coverage. Purchasing individual dental insurance is an option for seniors who may have lost dental benefits once they retired.
If you are 65 years old or older, you’re more likely to have gum disease, tooth loss, or oral cancer. In fact, 68% of adults over 65 have gum disease³. Having a way to help defray the costs for dental services can be especially helpful since you may be on a fixed income.
Supplemental dental insurance for existing dental coverage
If you need extensive dental work (e.g., multiple crowns, root canals, implants, or oral surgery) annual maximums are likely to be reached, during a calendar year.
Waiting periods for coverage is another time when having a supplemental plan could help. Some dental policies have waiting periods of a year or more for certain services.⁴ A supplemental plan that does not have a waiting period could cover dental work while waiting for the primary plan to become effective.
Considerations if you have dual dental insurance coverage
While over 20% of Americans had no form of dental insurance in 2017⁵, some people find themselves covered by more than one plan.
Dual coverage usually happens when two spouses or partners both have dental benefits through their employer. If you find this to be the case, you can either compare the costs of premiums, co-pays, deductibles, and coverage options to choose just one employer-sponsored plan to cover your whole family, or keep both policies and enjoy the advantages of dual coverage.
The plan that you have at your job is considered the primary plan. Any plan that you are on as a dependent is the secondary plan. Your primary plan pays out any designated benefits as though you had no additional insurance plan. Your secondary plan is supplemental and may cover some remaining out-of-pocket expenses. Secondary plans usually will not accept a claim until after a primary claim has been submitted and paid.
Coverage for children insured under two plans is a bit trickier. Most insurance companies use a method called the birthday rule to determine which plan is primary for dependent children. If children are eligible for dental benefits from two policies, the plan held by the parent or guardian with a date of birth earliest in the calendar year becomes the primary plan for the dependent children.⁶ Keep in mind, however, that sometimes state laws and regulations determine dependent coverage. While the birthday rule is common for most dual coverage, certain situations, such as when parents are divorced or separated, require the courts to determine which parent’s plan covers the children.
Should you find yourself with two or more dental insurance policies, there are some considerations to keep in mind. First, compare the cost of the premiums for both policies and the levels of coverage, copays, and deductibles. Then, find out how those amounts differ if you or your spouse choose not to include dependents
Having dual coverage might be beneficial for families who have a lot of dental treatment needs. When the primary plan finishes paying a claim, you can file the remaining balance with the secondary plan, lowering your out-of-pocket fees.
How does dual coverage dental insurance work?
If you are covered by multiple dental insurance policies, you are likely entitled to additional benefits. However, this does not mean that your combined dental insurance plans will ever pay more than 100% of any procedures you undergo. A process called coordination of benefits (COB) determines which plan pays what for dental care, ensuring that the cumulative insurance benefits are not duplicated and don’t exceed 100% of the total charges.
Most plans have a COB clause indicating how benefits will be paid if you have multiple insurance policies. In other cases, state laws and regulations might determine the coordination of benefits or insurance companies might coordinate benefits together. Dual coverage dental insurance does not mean that you have double coverage. For example, if each plan allows you to have your teeth cleaned twice each year, you cannot file claims for four cleanings. If your primary plan covers 100% of preventive care, you will not have to pay any money out of your own pocket for the preventive service; but your secondary insurance will likely not pay the fees again if the primary already paid the bill in full. You will not get any extra money from the secondary plan. For example, if you have a service that is covered at 50% by your primary plan, the secondary will pick up all or part of the other half of the charges, depending on their COB plan.
While rarely will dual coverage dental insurance result in you having no out-of-pocket expenses at all, having multiple insurance coverage can help to lower those amounts.
Pros and cons of having two dental insurance policies
If you have or are considering getting dental coverage by multiple dental insurance policies, there are several advantages as well as disadvantages to consider.
Pros of dual dental coverage
Helps to save on out-of-pocket costs. Dual coverage can allow you to save even more than you might if you only had one insurance plan.
More coverage. Having multiple dental insurance policies can offer you more coverage in case you or a dependent need a major procedure done. Plus, having more than one plan is likely to help you avoid any gaps in coverage in case you or your spouse leaves their job.
Reduces financial stress. If a dental issue arises, it is better to have more insurance than no insurance. Having two or more dental insurance plans can allow you to worry less.
Cons of dual dental coverage
Unnecessary expense. Many dental insurance policies are comprehensive enough on their own. You might be better off choosing just one plan, especially if your employer charges a premium to cover dependents.
Can be difficult to navigate. Coordination of benefits can get complicated – and submitting all your claims twice can be a hassle. It is usually simpler to stick with just one insurance plan.
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 coverage—having two or more dental insurance policies—can offer financial benefits when you or a family member needs expensive dental treatment.
Supplemental policies—those purchased specifically to cover dental treatment that is not included in a medical or other dental plan (the gaps)—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.⁷ 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.
Links to external sites are provided for your convenience in locating related information and services. Guardian, its subsidiaries, agents and employees expressly disclaim any responsibility for and do not maintain, control, recommend, or endorse third-party sites, organizations, products, or services and make no representation as to the completeness, suitability, or quality thereof.
Insights for the people.
Join our new digital insurance community that includes tips, resources and useful information from Guardian Direct.
https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices, accessed August 2020
http://www.ada.org/en/~/media/ADA/Member%20Center/FIles/DBCQ\_DBISCoordinationofBenefits\_2015Mar10, accessed August 2020