The second dental plan paid $12.50 of a $73 filling
Two plans on one filling pay what one good plan would have paid, and MetLife's own worked examples show where the second plan's share stops: the coordination arithmetic, the 2027 premiums it is measured against, and the cash routes that beat a second card.
Three people asked the same question in the dental insurance forum over the past seven days.
A 45-year-old facing major work said his plan covers 50% and asked what other coverage he could buy 1. A parent asked how payment works when his children are on Delta Dental through his job, at $32 a month for three, and also on United Concordia pediatric dental through their ACA plans 2. A third reader, still a dependent, will be covered under both parents' plans and wants to know what each one pays 3.
Each of them is asking what a second card adds. The 2027 federal plan documents answer with worked examples, and on one of those examples a second dental plan pays $12.50 of a $73 filling.
Open season runs Nov. 9 through Dec. 14 4. That leaves this week to price the second plan before paying for it.
The second plan pays the gap
MetLife's 2027 federal dental brochure says its benefits coordinate with another dental plan under "traditional COB provisions" — coordination of benefits — and prints four worked examples 5.
Start with the in-network one, where MetLife is the second plan and a regular dental plan is first. A two-surface amalgam filling is billed at $121, and the in-network fee is $73. The first plan pays $60.50 of that fee, leaving $12.50 unpaid. MetLife's own benefit for the same filling would be $51.10, at 70% under the High option. MetLife pays the $12.50 that is left, and the patient pays $0 5.
So the second plan's payment is the smaller of two numbers: whatever remains of the allowed charge, and its own benefit for that service.
All four examples assume deductibles are met and the annual maximum is untouched.
| The other coverage | Allowed charge | First plan pays | Left of the allowance | Second plan's own benefit | Second plan pays | You pay |
|---|---|---|---|---|---|---|
| A regular dental plan, in network | $73 | $60.50 | $12.50 | $51.10 | $12.50 | $0 5 |
| A regular dental plan, out of network | $113 | $96.80 | $16.20 | $67.80 | $16.20 | $0 5 |
| Your FEHB or PSHB medical plan, in network | $60 | $16 | $44 | $42 | $42 | $2 5 |
| Your FEHB or PSHB medical plan, out of network | $90 | $16 | $74 | $54 | $54 | $38 5 |
The first two rows answer the common question. Two dental plans pay the allowed charge between them and stop there: $73 on a $73 fee, $113 on a $113 fee. The bill above that allowance still lands on the patient, which is why the out-of-network row starts from a $113 bill and a $113 allowance.
The last two rows show the other limit at work. A medical plan pays $16 and leaves $44 of a $60 fee. MetLife's own benefit is $42, which is less than the $44 gap, so MetLife pays $42 and the member pays the $2 left over 5. The second plan's own benefit is a ceiling on what it adds.
Run the same test on any pair of dental plans. The second one adds the difference between its own benefit and what the first plan left of the allowance. Where the first plan's payment already covers the allowance, the second plan's share is zero.
Put a round number on it: a $1,000 allowance at a 35% plan share is $350 of benefit under either plan. The first plan pays its $350 and fills the allowance, so the second plan has nothing to add.
Which pair of plans can add up
The federal rule is printed in both brochures. Delta says its program follows a requirement that the FEHB or PSHB plan "will always be the first payor," and asks you to hand your dental office both cards at every appointment so the claim goes to the medical carrier first 6.
MetLife states the same rule and gives the reason: most FEHB plans already include some dental benefits, and presenting both cards is how you collect under both programs 5.
The pair that adds is a medical plan carrying a small dental benefit, plus a dental plan. The pair that tops up is two dental plans, where the second one fills what the first leaves of the allowed charge, capped by its own benefit.
What the top-up costs in 2027
Rating region 1, self-only, monthly and by the year:
| Plan and option | Monthly | Per year | Class C member share, in network | In-network annual maximum |
|---|---|---|---|---|
| Delta Dental Standard | $23.68 | $284.16 | 65% | $1,500 67 |
| Delta Dental High | $39.67 | $476.04 | 50% | Unlimited 47 |
| MetLife Standard | $24.03 | $288.36 | 65% | $2,000 57 |
| MetLife High | $40.76 | $489.12 | 50% | Unlimited 57 |
Both carriers pay 100% of Class A work in network, 55% of Class B and 35% of Class C on the Standard options, and 70% of Class B and 50% of Class C on the High options 45.
The 2027 Delta sheet repeats the 2026 sheet line for line on shares, maximums and orthodontic limits 8. The coinsurance design a second plan would be stacked against has not moved.
Delta also states that no waiting periods apply to any covered service, orthodontics included, so a new plan's first month pays the same share as its twelfth 4.
For a family in the same region, Delta Standard is $71.02 a month and MetLife Standard is $72.06 7. Those are the numbers to set against the top-up you can estimate from the examples above.
Which plan pays first
A federal enrollee holding a medical plan and a dental plan sends the claim to the medical plan first, and both brochures say so 56.
For a child covered by two parents' plans, MetLife's vision brochure sets out the convention: the plan of the parent whose birthday falls first in the calendar year is primary, and where the birthdays match, the plan that has covered the child longest takes first position 9.
Paperwork decides whether the second plan pays at all. The office bills the primary, receives its explanation of benefits, and sends that page along with the secondary claim. Delta puts the responsibility on the member to tell the dentist about both plans so the claim is routed correctly 6.
MetLife's in-network coordination example leaves the patient owing $0 once both plans have paid 5. A claim that reaches one carrier only produces a larger bill, and the bill usually arrives before the correction does.
What this week's threads are deciding
The parent with two sets of children's coverage has an orthodontic decision in front of him. His ACA plan carries a $1,000 orthodontic limit, and one child needs braces 2.
Delta's Standard option pays 50% of orthodontic treatment up to $2,000 per child over the plan's lifetime, and its High option $3,500 per child 4. MetLife's Standard option carries a $1,500 orthodontic lifetime maximum and its High option $3,500 per child 5.
Which plan pays first decides which lifetime maximum gets spent first, and the birthday rule settles that. The other number worth having before the orthodontist visit: his $32 a month is $384 a year for three people, against a plan paying 100% of in-network cleanings, X-rays and exams 4.
The reader who will be a dependent on both parents' plans is deciding which card to hand over first. The birthday rule answers that, and the table earlier in this piece answers what the second card then pays 3.
The 45-year-old with major work ahead is choosing between a second premium and a negotiated price. On Nov. 1 another reader in New York showed the size of the gap that makes a second plan look attractive: $514 for X-rays, $1,344 for an extraction, a $250.20 check from MetLife, and a $1,500 annual maximum 10.
A second dental plan would cover part of what that maximum leaves behind. The examples above cap that part at the second plan's own benefit, and the second premium runs $284 to $489 a year at self-only rates 7.
The cash price route
On Oct. 27 a reader facing multiple root canals and crowns found a university clinic charging $500 for a root canal, $150 for a core buildup and $800 for a porcelain-and-metal crown. He asked whether he can pay those prices and still claim his plan's out-of-network benefit 11.
Those three prices total $1,450 for one tooth. A national price list puts a molar root canal at $1,337 and a porcelain crown at $1,399, or $2,736 for the pair 12. Penn Dental Medicine publishes uninsured ranges of $700 to $1,500 for a root canal and $800 to $2,500 or more for a crown, and says its teaching clinics accept most insurance plans and Medicaid 13.
The claim is the part to pin down before the appointment. Out-of-network benefits are a percentage of the plan allowance, and both brochures set that allowance equal to the in-network allowance for the same service 56.
Where a clinic's bill sits below the allowance, the plan's percentage of the allowance is the larger figure. Ask the carrier, in writing, how it prices a claim whose charge comes in under the allowance. Ask the clinic whether it bills insurance directly; Penn's clinics do 13.
Put the two routes side by side. The school case runs $1,450 against $2,736 at the national average, which is 47% off before any reimbursement arrives. A second dental premium of $288 a year buys a payment capped by the second plan's own benefit.
Where a discount plan fits
The 45-year-old's question — what other coverage can I buy — has a third answer besides a second insurance plan and a clinic. A dental discount plan sells a fee schedule rather than a benefit. Careington, which sells them, describes the product as different from insurance, usable on its own or alongside a current insurance plan, with the member paying the discounted rate to the dentist at the counter and no limit on how often the card is used 14.
A discount plan pays the dentist nothing, so there is no claim to coordinate and no top-up to calculate. It reduces the bill, and any insurance claim then runs on that smaller bill, with the plan's allowance still capping the insurer's share 5.
Read alongside the school-clinic prices above, that gives three ways to reach a lower bill: a second insurance plan that pays a capped remainder, a discount card that cuts the fee before insurance sees it, and a teaching clinic whose cash price is already below the national average 12.
Two vision cards, one allowance a year
The vision side runs on a shorter clock. MetLife's federal vision plan covers one routine exam, one pair of lenses and one eyeglass frame per calendar year, with contacts available in place of glasses 9.
The 2027 frame allowances, after the $20 materials copay on the Standard option: $190 for featured frames, $150 for standard frames and $85 at Costco, Walmart and Sam's Club. The High option pays $250, $200 and $200 with no copay, and out-of-network frames reimburse up to $70 9.
Each plan measures its own calendar-year allowance, and when two plans are billed for the same pair of glasses one of them pays first. The brochure settles which: against a spouse's non-federal vision plan, MetLife is primary, and for a child the birthday rule decides 9.
What the second plan adds for that purchase is a question for its member services, asked with the first plan's explanation of benefits in hand. An answer that arrives before you order the glasses is worth more than one that arrives after.
Before you add a second plan
- What would the second plan pay as secondary for your exact treatment? Send it the first plan's explanation of benefits and ask for the figure in writing.
- Is the other coverage a medical plan with dental benefits, which stacks, or a dental plan, which tops up 5?
- Which plan is primary for your child, and did the office bill that one first 9?
- What does the second premium cost for a year — $284.16 to $489.12 self-only at rating region 1 rates 7?
- How much annual maximum remains on each plan this year, and when does it reset 5?
- For a cash-price route, what is the clinic's price, and what will the plan pay on a claim where the bill sits under its allowance 13?
Enrollment runs Nov. 9 through midnight Eastern on Dec. 14, and coverage starts Jan. 1, 2027 4. The second card you carry on Jan. 1 is the one whose top-up you can price this week.
References
- 1
- 2
- 3
- 42027 Delta Dental Plan Highlights
www1.deltadentalins.com
- 5
- 6
- 72027 FEDVIP Dental Premiums\
opm.gov
- 82026 Delta Dental Plan Highlights
www1.deltadentalins.com
- 92027 The MetLife Federal Vision Plan
fedvip.metlife.com
- 10Update on dental insurance
reddit.com
- 11
- 12Dental Exam and Procedure Costs
carecredit.com
- 13The Cost of Dental Care: A Hidden Barrier to Healthcare Access
penndentalmedicine.org
- 14What you need to know about Dental Discount Plans
careington.com
This story was produced automatically by a channel. One sentence is all it takes for Neodrop to keep producing for you.