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If you work in a dental office, you’ve likely encountered patients who are confused by their dual insurance plans or delay care because they don’t understand their coverage. That’s why it’s important to know how secondary dental insurance works. It helps patients afford care, reduces financial hesitations, and keeps your revenue cycle healthy. Secondary insurance doesn’t double a patient’s benefits, but when coordinated correctly, it can fill the gaps left by primary coverage, covering deductibles, coinsurance, or treatment balances. In this article, we’ll walk through how secondary dental insurance functions, when it’s most beneficial in your practice, and how your team can manage it with less confusion and more confidence.
Apr 25, 2025
Primary vs. Secondary Insurance in Practice
Primary dental insurance is the main plan, the first one billed, and usually covers a large chunk of treatment costs. It’s often through an employer or purchased independently. In most practices, this is the plan you’ll deal with first when estimating coverage and submitting claims.
Secondary dental insurance acts as a backup. If a patient has two plans, the secondary one may cover what the primary didn’t. For example, if a procedure costs $1,000 and the primary covers 80% ($800), the secondary plan might cover the remaining $200, depending on its limits and coordination rules.
It’s not a replacement for the primary plan, but a supplement. Understanding how both plans work together helps your team reduce unpaid balances and makes it easier for patients to say yes to needed care.
Key Terms in Primary and Secondary Dental Insurance Coverage
Understanding the key terms when dealing with primary and secondary dental insurance can help you navigate the process more smoothly. You may also find this dental terminology guide helpful.
Annual maximums: Most plans cap yearly coverage between $1,000 and $2,000. If a patient reaches that limit, secondary insurance can take over, helping them complete treatment without breaking the bank, or avoiding it altogether.
Deductibles and coinsurance: Patients usually pay $50–$200 annually before insurance coverage. After that, they may still owe 20% to 50% of treatment costs. Depending on how benefits are coordinated, a secondary plan might help with both the deductible and the remaining balance.
Network participation: Not all plans use the same provider network. A dentist who’s in-network for one plan may be out-of-network for the other. That can significantly affect patient costs and your reimbursement rate.
Categories of coverage: Both primary and secondary plans divide procedures into three categories. Knowing how both plans cover these categories helps you set realistic expectations during treatment planning.
Preventive (exams, cleanings, X-rays)
Basic (fillings, simple extractions)
Major (crowns, bridges, root canals, implants)
Waiting periods: Some plans have waiting periods for major services, often several months. These delays can apply to secondary plans even if the primary would cover the procedure immediately.
Coordination of Benefits
Coordination of Benefits (COB) is the process insurers use to determine which plan pays first when a patient has dual dental coverage. The goal is that the combined payments from both plans do not exceed the total cost of care, protecting against overpayments and keeping billing clear for both practices and patients.
While COB can add complexity to claims management, understanding the rules helps dental teams navigate coverage more efficiently and avoid reimbursement delays. For practices within larger organizations like DSOs, centralized insurance coordination can help simplify this process.
Key COB rules:
If a patient is an employee on one plan and a dependent on another, the employee plan is primary.
For children covered by both parents, the "birthday rule" applies: the parent whose birthday falls earlier in the year has the primary plan.
Court orders override the birthday rule in custody cases.
Active employment coverage takes precedence over COBRA or retiree plans.
Example: If a child is covered by both parents and Mom’s birthday is in March while Dad’s is in September, Mom’s plan pays first. If her plan covers 80% of a $1,000 treatment, Dad’s plan may cover all or some of the remaining $200.
The Claim Process: Step by Step
When a patient has secondary insurance, the claim process involves two rounds of billing:
Submit to the primary insurer. Your office sends the initial claim to the primary plan.
Receive the EOB. The Explanation of Benefits shows what the primary plan paid and what remains.
Send to the secondary insurer. The secondary claim includes the EOB and treatment codes.
Secondary plan review. The insurer determines what it will cover based on its own terms and COB rules.
Finalize billing. The office applies any remaining balance to the patient or confirms that everything has been covered.
This process can take longer than single-plan billing, but when done right, it can reduce out-of-pocket costs for patients and improve collections for your practice.
Many offices now use AI dental insurance verification tools to speed up dual insurance claims. But if your practice isn’t in-network with the secondary plan, the patient may need to submit the second claim independently.
Limitations of Secondary Coverage
Secondary dental insurance offers valuable support, but it isn’t unlimited.
Non-duplication of benefits is a key limitation. If the secondary plan would have paid 50% of a procedure as primary, but the primary already paid that much, the secondary won’t contribute more.
Both plans also have their own annual maximums, often around $1,000 to $1,500. Reaching the secondary limit means the patient is back to paying out of pocket, even if their primary plan has already been maxed out.
Secondary plans may:
Cap how often cleanings or exams are covered
Exclude specific procedures or materials
Require their own waiting periods
Reduce coverage if the provider is out-of-network
Example: If a crown costs $1,200 and the primary pays $600 (50%), the secondary plan might not cover the full $600 difference. Instead, it could pay just $600 total, which is what it would have paid as the primary.
Why This Matters to Your Practice
When secondary insurance covers what the primary doesn’t, patients are more likely to proceed with treatment, and your revenue cycle management becomes more orderly.
Let’s say a patient needs a $2,000 root canal. The primary plan covers 60% ($1,200). The secondary plan may cover an additional $700, leaving only $100 for the patient. That’s a big difference compared to $800 out of pocket with one plan.
Secondary coverage also helps patients who hit their annual max early in the year, especially those with ongoing dental issues or large treatment plans.
Some secondary plans even cover procedures that the primary doesn’t, such as implants or certain cosmetic services. This makes it easier for your office to offer high-value treatments that might otherwise be financially out of reach.
Plus, having two plans means access to a broader provider network. If your office isn’t in-network for one, you might be for the other. This helps you retain patients who might otherwise go elsewhere.
When Secondary Insurance Pays Off
Secondary dental insurance is beneficial in these situations:
Patients who need extensive restorative work. Crowns, bridges, and implants can quickly max out a plan. A secondary plan can take over when the primary plan hits its ceiling.
Chronic dental conditions. Patients managing gum disease or other long-term issues benefit from extended coverage across multiple visits.
Seniors with Medicare. Since Medicare doesn’t cover dental, many older adults use secondary plans to maintain oral health.
Patients between jobs. Secondary plans offer continuity when employer coverage lapses or includes waiting periods.
Plans with gaps. If the primary plan excludes a needed procedure, secondary coverage may fill that gap.
To help patients determine if secondary coverage or other dental payment programs make sense, estimate their annual dental expenses, subtract what the primary covers, and compare that against the cost of a supplemental plan. If the savings outweigh the premium, it's likely a smart choice.
Evaluating Plans: What to Watch For
When advising patients, updating your practice financial policy, or exploring in-house dental plans, look at how well a secondary plan complements the primary one. Key considerations include:
What services are covered? Does the secondary fill the gaps left by the primary?
Are waiting periods reasonable? Delays can affect treatment timelines.
Do both plans cover your office? Network compatibility is key.
Is there a non-duplication clause? This limits what the secondary will pay.
What are the exclusions? Especially for ortho or cosmetic procedures.
Calculate out-of-pocket costs before starting major work using pre-treatment estimates and comprehensive dental treatment plans. If patients have employer-sponsored options, encourage them to compare rates before purchasing a standalone plan.
Maintain Smooth Operations of Your Practice with the Right Team
Understanding secondary dental insurance can significantly improve dental offices' and hygienists' management of patient care and billing. Productive communication with dental patients about their insurance options can reduce cost barriers, increase treatment acceptance, and secure more predictable collections for your practice.
Whether you’re dealing with families, seniors, or patients undergoing major restorative work, secondary dental insurance often makes the difference between delayed care and completed treatment.
Of course, navigating these benefits and maintaining smooth operations takes the right team. That’s where Teero comes in.
Teero helps dental offices stay fully staffed with qualified hygienists. Whether you need temporary coverage or a permanent team member, Teero makes it easy to fill gaps and keep your practice running smoothly.