Private dental insurance can be an overwhelming topic for many individuals. It often takes someone with training and expertise to fully understand the details and verbiage associated with various programs. If you are considering enrolling in your employer’s plan, you may wonder about some of the terms used as part of your policy – one of which is “deductible.” Learn more about this term and how you can start saving more each time you visit the dentist’s office.
What is a Deductible?
Most, not all, dental insurance policies have what is called a deductible. This is the designated amount your insurance company deems you responsible for paying before any available benefits can be used.
The way it works is that your insurance company will agree to start paying more for preventive and restorative services once you agree to meet your deductible. Typically, it is a low amount and can generally be met early on in the year.
One important thing to remember, though, is that your deductible will reset to “0” on January 1 each year. The reason is that insurance companies typically build their plans to be “good” for one calendar year, meaning you can use the available funds and benefits within 12 months.
How Does a Deductible Work?
If your deductible is $50, you will be required to pay this amount before you can expect to save on the services you receive at your dentist’s office.
An example might be that you require a minor restorative procedure that costs $300. If you have yet to meet your deductible, the total cost will be $350. Once you pay the $50 out of pocket, the original $300 will remain. This will be the amount your insurance company will agree to partially cover. Depending on the breakdown of benefits, they might agree to pay 70-80% of the total cost. This means that your insurance company will pay about $240, while you pay the remaining $60 out of pocket.
What Happens Once Your Deductible is Met?
Once you meet your deductible, you do not have to worry about paying it again until the following year. It is only at this time that you will need to be mindful of your annual maximum, which is the total amount your insurance company agrees to pay in a single calendar year.
For any additional dental treatments you need throughout the year, your insurance company will pay a portion of the cost (as long as it is a covered procedure, like a dental crown, tooth-colored filling, root canal, etc.). If you get close to going over your annual maximum, you may need to inquire about how you can avoid high out-of-pocket expenses and whether your treatment can be spread out over calendar years.
You don’t have to try and navigate your dental insurance policy on your own. Allowing a trusted member of your dental team to help you understand the process and your available coverage will ensure you feel more confident in making well-informed decisions about your oral healthcare.
About the Practice
The dental team at Indy Dental Group wants you to get the most out of your dental insurance plan, which is why we work to identify ways you can save. By helping you better understand your plan and maximize your benefits, we can help you avoid high out-of-pocket costs while ensuring you get the care you need. If you’re unsure about the various terms used within your dental insurance policy, contact us at (317) 846-6125.