Can You Use 2 Insurances for Orthodontics?

Having straight, healthy teeth is important, but orthodontic treatment like braces or Invisalign can be expensive. Using two dental insurance plans to cover orthodontics may help reduce the costs. This article explains how you can use two dental insurances for orthodontics.

Overview of Orthodontic Insurance Coverage

• Orthodontic coverage is not automatically included in dental insurance plans. You need to verify that your plan includes orthodontic benefits.

• Orthodontic benefits typically have a lifetime maximum benefit that covers a percentage of the total treatment cost, usually around 50%. For example, if the lifetime max is $2000, the plan will cover 50% of costs up to $4000.

• Insurance pays out orthodontic benefits over the entire course of treatment, not in one lump sum. Monthly or quarterly payments are made.

• Many plans have waiting periods before orthodontic coverage kicks in. This is important to know if you’re considering new insurance.

• Plans may cover braces for adults and/or children. Check whether you will be covered.

How Dual Coverage Works for Orthodontics

Having two dental insurance plans that include orthodontic coverage can reduce your out-of-pocket costs, but benefits are not simply doubled. Here’s how it works:

• One plan will be the primary insurance, the other secondary. The primary plan pays out first.

• The secondary plan will pay toward whatever costs remain after the primary plan has paid, up to the total treatment cost.

• Combined benefits from both plans cannot exceed the total agreed-upon charges with your orthodontist.

• You may still have a co-pay, but it will likely be lower than with just one insurance plan.

• State laws affect how dual coverage coordination works. Check details with both insurance companies.

Determining the Primary and Secondary Insurance Plans

• The plan where you are the member (not a dependent) is primary.

• If you have coverage through two jobs, the plan you’ve had longer is primary.

• For spouses, the older spouse’s plan is usually primary, based on birth month and day, not age.

• The secondary plan may require seeing payment details from the primary before paying out.

Key Considerations for Using Two Plans for Orthodontics

• Verify that both plans include orthodontic coverage and coordination of benefits.

• Understand each plan’s lifetime max benefits, waiting periods, covered services, and coordination rules.

• Time the start of treatment carefully if one plan has a waiting period to maximize benefits.

• Submit claims to the primary plan first, then provide details to the secondary plan.

• Keep both insurances active for the duration of orthodontic treatment.

• Get benefit estimates from both insurers to determine potential out-of-pocket costs.

What if I Get New Orthodontic Coverage Mid-Treatment?

If you gain dental insurance with orthodontic benefits after starting treatment, the new plan may cover a prorated portion of the remaining treatment costs. Check if the plan covers “work in progress” ― ongoing orthodontic treatment. You will need to provide details like start date, expected treatment length, and amount paid to date.

Can I Use 2 Dental Plans if I Already Hit the Lifetime Max on One?

If you’ve exhausted the lifetime orthodontic benefit on your primary dental plan, the secondary plan may still provide coverage if you haven’t reached its lifetime max. This can help cover continued treatment or retention after braces. Make sure to coordinate benefits appropriately.

The secondary plan may not pay if the primary has met its obligation by paying out the full lifetime max benefit. Check your plan details.

Answers to Common Questions About Using 2 Dental Plans

Can I use 2 PPO plans for braces?

Yes, you can coordinate benefits from two dental PPO plans for orthodontic treatment. Follow the coordination of benefits rules for each plan.

What if both plans have a non-duplication of benefits clause?

If both plans state they will not duplicate benefits, you may not get any secondary coverage. Total benefits would be limited to the higher of the two lifetime maximums.

What if one plan covers 50% and the other 80%?

The primary plan will cover based on its benefit level (50%) and the secondary will pay based on its benefit level (80%) up to the total treatment cost.

Can I use dual insurance if I switched jobs mid-treatment?

Yes, just make sure both plans cover work in progress. The new plan will likely prorate benefits based on the remaining treatment timeline.

What if I’m covered as a dependent on both plans?

Dependent coverage coordination works the same way. The parent whose birth date is earlier in the year is primary, and the other parent’s plan is secondary.

Tips for Using 2 Dental Plans for Orthodontics

• Always verify benefits and coordination rules with both insurers before starting treatment

• Provide complete and accurate information to maximize your coverage

• Keep both plans active for the entire duration of orthodontic treatment

• Submit claims and paperwork meticulously and on schedule

• Follow up on claims to ensure proper payments from both insurers

• Keep detailed records of treatment timelines, costs, benefits paid, etc.

Conclusion

Having two dental insurance plans with orthodontic coverage can help lower out-of-pocket costs for braces or aligners. Coordinating benefits appropriately between the primary and secondary insurers is key. Check plan details thoroughly, provide complete documentation, and maintain both policies throughout treatment to maximize your total benefits. Two insurances can make orthodontics more affordable!