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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. It’s important to understand the costs, terms, and rules of your plan so you know what to expect once it comes to using it.
Your annual or monthly premium isn’t all you’ll have to budget for. Your deductible amount will also play a factor in how much you pay out-of-pocket for dental treatment each year. Not all dental insurance plans have a deductible, but if yours does, make sure you know what it is, and you’re prepared to pay it.
A dental insurance deductible is the 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 $100, your plan kicks in once you’ve paid that much in related dental care expenses. If you’ve used or purchased other types of insurance, chances are you’ve dealt with insurance deductibles before. No matter the type of insurance, deductibles usually behave the same way. An insurance deductible is the amount you pay out-of-pocket when you make an insurance claim before your benefits kick in.
Some dental insurance costs, such as premiums, are paid up front. This is the fee you pay for an insurance plan. On the other hand, dental insurance deductibles go towards actual dental care costs before your plan starts to pay for covered dental treatment costs.
Depending on the dental insurance plan, some services, such as cleanings and diagnostic services, are often covered outside your deductible. That means if you do not require dental care aside from diagnostic or preventive services one year, you won’t have to pay anything toward your deductible.
Dental insurance plans are usually based on a calendar year, though some policies roll annually depending 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 pay the entire deductible.
Health insurance deductibles are like dental insurance deductibles. Health insurance deductibles usually reset annually. The deductible is the dollar amount a policyholder is responsible to pay for covered health care services before the health insurance company starts to pay.
Medical insurance deductibles are typically higher than dental insurance deductibles. High-deductible health plans are becoming increasingly common, with the average deductible at $1,491 for individuals and $2,788 for families¹.
Health insurance premiums as well as dental insurance premiums can count as a tax-deductible medical expense if you itemize your deductions. However, you can only deduct medical expenses after they exceed 7.5% of your income². Consult your tax, legal, or accounting professional regarding your individual situation.
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.
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. Check with your dental insurance provider.
Not all dental insurance plans have deductibles. There are two main types of dental insurance plans, Dental Preferred Provider Organizations (DPPO) and Dental Health Maintenance Organizations (DHMO).
DPPO plans typically have deductibles, along with higher out-of-pocket costs overall. The main advantage of DPPOs is that they allow you to visit nearly any dentist without a referral and still receive full or partial coverage for the services.
DHMO plans do not have deductibles and typically have lower premiums. As long as you stay in your network, your co-payment will be your only additional out-of-pocket cost. However, DHMO plans typically encourage you to visit the dentists in your network to receive full coverage.
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.
A dental insurance premium is the amount you pay your insurance carrier in exchange for dental coverage. Typically, dental insurance involves some type of premium.
There’s often a relationship between dental insurance premiums and dental insurance deductibles. Typically, choosing dental insurance with a higher premium help to lower your deductible, while dental insurance with a lower premium will often have a higher deductible. Be sure to look at both the deductible amount and the applicable premium amount when budgeting for a plan.
A copay is a fixed cost you pay up front each time you visit your dentist, regardless of the type of treatment you receive. DPPO plans usually don’t have any copays.
Coinsurance is the remaining cost after your dental insurance coverage kicks in. It’s the percentage you pay directly to your dentist. For example, if 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 remainder $100, and you’ll then pay the remaining $20. That remaining $20 is the coinsurance cost.
Some dental insurance plans have an annual maximum. Also referred to as a maximum amount or a plan maximum, this is the total your dental plan will pay toward your care during a calendar year.
With all these possible out-of-pocket costs, you might be wondering if dental insurance is worth it for you. But the truth is, dental insurance has the potential to pay off in a big way. Dental insurance pays for preventive care, like cleanings and X-rays, that can keep you healthy overall, but it also helps pay for more extensive, costly, and often unexpected expenses, such as fillings, crowns, and root canals.
And, if you have young children, regular dentist visits can be an important part of your child’s lifelong oral health. Tooth decay is the most common childhood diseases —often causing pain that impacts a child’s sleeping or eating habits, and it may lead to school absences³. Dental insurance helps pay for taking care of a child’s oral health.
If your employer doesn’t offer dental insurance, you can purchase dental insurance from a dental insurance company over the phone, through a broker or online. Dental insurance helps pay for preventive care, like cleanings and x-rays, that can keep you and your family healthy, but it also helps pay for more extensive, costly and often unexpected expenses, such as filings, crowns, and root canals.
Dental insurance deductibles may seem confusing at first, but they’re relatively straightforward. Remember to consider the cost of your annual deductible as well as other out-of-pocket costs as you’re shopping for the best dental insurance plan for you and your budget.
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.
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https://www.cdc.gov/oralhealth/basics/childrens-oral-health/index.html, accessed August 2020
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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