Deductibles and Maximums

on November 20, 2013

Today we are going to finish up our series on dental insurance with deductibles and maximums. These are two different limits that are defined in your insurance plan. Again, each insurance plan is different, so, to be certain, check with your insurance carrier to find out what applies to your benefit package. Deductibles in dental insurance are similar to deductibles in medical insurance. If you do have a deductible, you will have to pay it before the insurance will begin their coverage.

Deductibles in dental insurance can be as low as $25. Some insurance plans do not apply your deductible to preventative coverage – such as your routine hygiene appointment. Instead they pay the hygiene appointment at their normal coverage level, and apply the deductible to any additional services you need to have done – such as a filling or a crown. Other dental insurance plans don’t have a deductible at all.

Unlike deductibles, all dental insurance plans have a plan maximum. The plan maximum is the amount of money the insurance company will pay in a coverage year. Plan maximums renew at the beginning of the coverage year and any un-used benefits are lost at that time. If you have treatment that needs to be completed, you can work with your dentist to plan out a way to get the most out of your insurance and ensure that you don’t lose any of your benefits. To facilitate this, it is best to know how much is allocated to your plan maximum and what your insurance considers a coverage year.

A coverage year is not necessarily the same as a calendar year. Some plans use a school year as a coverage year, and some use your start date. Find out from your insurance what your coverage year is prior to starting major treatment to ensure you don’t go over your plan maximum. If you have new insurance, check to see if you have a waiting period for major treatment as well.

Over the past couple of weeks, we’ve shared several tips to help you understand your insurance. You may have noticed that the recurring theme is that you should check with your insurance company. Your insurance is a contract between yourself, your employer, and the insurance company. The more knowledge our patients have about their benefits, the better able we are to provide affordable quality dentistry. Let us know if you have any other questions about insurance, and we’ll be sure to answer them in a future post.

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