Whether you already have a dental insurance plan, or you’re looking for a new provider, you may be wondering exactly how this type of coverage works. After all, protecting your teeth and gums is quite different from say, your automobile or even the rest of your body. Here’s a closer look at one specific dental insurance detail, the deductible, and what it means for both individuals and families.

What is a Deductible?

A dental insurance deductible is a pretty straightforward concept. They are basically the annual dollar amount you pay directly to your dentist for any covered treatments before your dental insurance coverage kicks in.

Typically, deductibles are set for a 12-month period and will reset when the new coverage period starts. These may follow the calendar year, or they may reset on an annual basis depending on your individual plan.

How do Dental Insurance Deductibles Work?

Now that you know what a deductible is, it’s important to understand how it works.  With dental insurance, there are typically two types of deductibles: individual or family.  Here’s a closer look at each.

Individual

With an individual deductible, your dentist will submit a claim with your insurance company, and you’ll first pay the deductible to the dentist before the insurance company pays anything. So, for example, if your treatment costs $300 and your deductible is $100 and your plan covers that particular treatment at 80 percent after your deductible is met, you’d pay the dentist $100 and have a remaining balance of $200. Then, your insurance coverage would take effect, paying 80% of the $200, reducing your out-of-pocket balance to $40. The balance is what is referred to as “co-insurance.”

Once you have met the deductible for the year, any covered treatment during the same period will be paid at the agreed upon rate as outlined in your dental insurance plan. This is because some treatments receive more coverage than others. To determine the exact level, check your individual plan for specifics, or ask your dentist’s billing team for assistance. So, for example, if you need another $300 dollar treatment and your insurance covers 80%, your dental insurance will pay $240, and you’d be responsible for the remaining $60.

Family

Family deductibles are a bit more confusing, but still relatively straightforward. Instead of meeting just an individual deductible, your plan has a family deductible, too. So, say for example you have a family of four sharing a plan and your family deductible is $300 dollars, with “per person” deductibles of $100 each. Your family’s deductible will be met only when three of the four deductibles are paid. Then, the regular terms would apply to any treatments covered by the dental insurance plan.

It is important to remember that different treatments are covered at different levels as determined by your insurer. Because dental insurance places such a heavy emphasis on prevention, services like your regular checkups and cleanings, annual X-rays, and oral cancer screenings are typically covered either at 100% and may not count towards your deductible. Furthermore, certain treatments may be covered at a higher percentage than others, while others may not be covered at all, such as those that are purely aesthetic like teeth whitening. There are sometimes exceptions to this rule if the procedure is considered medically necessary, but this depends on your plan and the treatment in question.

Remember, if used regularly, dental insurance can save you and your family a lot of money while protecting their teeth and gums. If you have any questions about your specific plan, call the provider on the number on your card, or speak to your dentist’s office. Often, they can explain confusing terms or help you figure out your exact coverage without having to spend your free time on hold waiting to talk to a human being at your insurance company.

About Our Practice

At Generations Dental Care, our skilled and compassionate team of dentists want to protect you and your family’s smile for, well, generations! That’s why we’re so pleased to welcome your dental insurance including in and out of network plans. To learn more about your coverage, or to book any treatment or service, visit our website or call us directly at 603-225-6331.