What is a Deductible? | Dental Insurance Deductible

What is a dental insurance deductible?

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A dental insurance deductible is the amount you’ll have to pay out of pocket before your benefits kick in.

If you’re currently shopping around for a dental insurance plan or if you’ve just purchased one, chances are you’ve encountered a lot of numbers and words you might not be familiar with. What’s more, every plan varies in terms of out-of-pocket costs and coverage amounts. It’s important to un-derstand the costs, terms, and rules of your current plan or the plan you’re considering signing up for so you know what to expect when it comes to using it.

Your annual or monthly premium isn’t the only dental insurance cost you’ll have to budget for. If applicable, your deductible will also play a factor in how much you pay out-of-pocket for dental treatment each year. Not all dental insurance plans involve deductibles, but if your plan has one, make sure you're prepared to pay it and you understand how it works.

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What is a deductible in dental insurance ?

A dental insurance deductible is an amount you must pay out of pocket each year before your plan starts to pay for covered dental treatment costs. It’s usually a specific dollar amount. For example, if your deductible is $50, your plan will pay benefits once you’ve paid that much out-of-pocket in related dental care expenses.

If you’ve used or purchased other types of insurance, chances are you’ve dealt with insurance deductibles before. An insurance deductible is an amount you will be responsible to pay out-of-pocket when you make an insurance claim before your benefits kick in. It typically resets each year, meaning you must meet your deductible each year before receiving benefits.

How do dental insurance deductibles work?

Some dental insurance costs are paid upfront. For example, in exchange for dental insurance coverage, you’ll pay a set fee each month, known as a premium. Dental insurance deductibles are paid upon receiving treatment. They go toward actual dental care costs before your plan starts to pay for covered dental treatment.

Depending on the dental insurance plan, the deductible may be waived for some services such as cleanings and diagnostic services. That means if you do not require dental care aside from diagnostic or preventive services for one year, you won’t have to pay anything toward your deductible for that year.

Dental insurance plans are usually based on a calendar year, though some policies roll annually de-pending on when you sign up. Your dental insurance deductible typically must be met once for the year, not for each visit, though sometimes it can take more than one visit to meet the entire deductible.

Let’s look at a few examples. Say you’re covered under an individual insurance plan with a $50 deductible that doesn’t apply to preventative care.

The first year, you only go to the dentist’s office for two cleanings. Since you only received preventative care, you don’t pay anything toward your deductible.

The following year, you get a small filling that costs $50. You pay the $50 out-of-pocket to cover the treatment, and that cost satisfies your deductible. That same year, you get a larger filling that costs $150. No deductible would be applied as it was met in the first claim. Then, any additional procedures you receive that same year don’t have any further deductible requirements.

Health insurance deductibles vs. dental insurance deductibles

Health insurance deductibles are a lot like dental insurance deductibles. Health insurance deductibles are a dollar amount a policyholder is responsible to pay for covered healthcare services before the health insurance company starts to pay. They usually reset each calendar year.

Medical insurance deductibles are typically higher than dental insurance deductibles as well.

How do dental insurance deductibles work on family plans?

Family dental insurance plans typically involve both an individual deductible and a family deductible. In this case, the individual deductible applies per person only until the family deductible is exhausted. 

For example, let’s say your family plan’s individual deductible is $50 and the family deductible is $100. Once the first two family members reach their individual $50 deductible, the family deductible of $100 is reached. They and any additional covered family members who seek treatment won’t have any further deductible requirements for a calendar year.

How do dental insurance deductibles work on family plans?

Some family dental insurance plans involve both an individual deductible and a family deductible. In this case, the individual deductible applies per person only until the family deductible is exhausted.

For example, let’s say your family plan’s individual deductible is $50 and the family deductible is $100. Once the first two family members reach their individual $50 deductible, the family deductible of $100 is reached. They and any additional covered family members who seek treatment won’t have any further deductible requirements for a calendar year.

Guardian Direct® dental insurance plans do not involve family deductibles. If applicable, each individual family member will have their own deductible they are responsible to meet.

What dental services count toward my deductible?

The dental services that count toward your deductible depend on your plan. Some dental insurance plans may not count diagnostic and preventive services toward your annual deductible. Others may count all services. Also, services received from an in-network dentist may not be subject to deductibles, while services received from an out-of-network dentist may be. Check with your dental insurance provider.

Do all dental insurance plans have deductibles?

Not all dental insurance plans have deductibles. There are two main types of dental insurance plans: Dental Preferred Provider Organizations (Dental PPO) and Dental Health Maintenance Organizations (DHMO).

Dental PPO plans typically have deductibles. The main advantage of Dental PPO plans is that they allow you to visit any licensed dentist and still receive full or partial coverage for the services.

DHMO plans do not have deductibles.

Deductibles & other out-of-pocket costs of dental insurance

Your annual deductible is just one of the costs to consider when determining how much you’ll be paying out-of-pocket with a dental insurance plan. Here are some terms you might encounter as you’re reviewing dental insurance plans and what they all mean.

Dental insurance premiums

A dental insurance premium is an amount you pay your insurance carrier in exchange for dental coverage.

Dental insurance copays

A copay is a fixed cost you pay upfront each time you visit your dentist, regardless of the type of treatment you receive.

Dental insurance coinsurance

Coinsurance is the remaining cost you pay after your dental insurance coverage kicks in. It’s the amount you pay directly to your dentist. For example, let’s say you get a $150 filling, you have a $50 deductible, and your insurance company covers the procedure at 80%. You’ll pay the $50 deductible, your insurance company will pay $80 from the outstanding $100, and you’ll then pay the remaining $20. That remaining $20 is the coinsurance cost.

Costs after reaching your dental insurance annual maximum

Some dental insurance plans have an annual maximum. Also referred to as a maximum amount or a plan maximum, this is the dollar limit on what your dental insurance will cover for a benefit year. All dental PPO plans have an annual maximum. Once the maximum is met, you are then responsible for any services incurred for the remaining benefit year.

Costs before your waiting period ends

Most dental insurance plans involve a waiting period on basic and major procedures due to the complexity of treatment. This means even after enrolling in a dental insurance plan, you may have to wait anywhere from 30 days to 12 months before certain procedures are covered. If you choose to receive treatment before your plan’s waiting period has ended, you may be responsible to pay the full cost out-of-pocket. Look over your dental insurance plan carefully to make sure you’re aware of any applicable waiting periods.

Guardian Direct has no waiting periods on preventative treatment such as cleanings and x-rays, so you can enjoy coverage for those procedures as soon as your plan is active.

What does no deductible mean on dental insurance & Insights

You don’t always have to reach a deductible before enjoying dental insurance coverage. With a DHMO plan, you can receive dental benefits without having to worry about reaching your deductible first. Plus, even if your plan does have a deductible, it may not apply at all for preventive and diagnostic services.

Both deductible and no-deductible dental insurance plans can help you save on the cost of dental treatment. Look over coverage amounts, premium costs, and other out-of-pocket costs before choosing to enroll in a plan.

We’ve compiled a list of resources to help you find an individual dental insurance plan that suits your needs, with or without a deductible.

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.

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Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.08/22)

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