When you use your dental insurance, it can make your oral care treatments more affordable. Navigating through your coverage can be confusing, especially when it uses terms you may not know. You may have seen the word “deductible” used throughout your plan. If you’re not sure what a deductible is, keep reading to learn more about it and how it works for dental insurance.
What is a Deductible?
A deductible is how much you have to pay out of pocket for your dental services before your insurance plan comes in to cover costs. A good thing to keep in mind is that deductibles typically renew on an annual basis. That means that once you have met that number in a calendar year, you don’t have to worry about it again until your benefits reset at the start of the new year.
Here’s an example of how a deductible would work if you haven’t met it yet:
Let’s say in this hypothetical situation your dental insurance deductible was $50, and you needed a dental treatment that was $250. Let’s also say that you haven’t had any previous dental work since January, so you haven’t put anything toward your deductible amount yet.
Before getting your treatment, you would have to pay your entire $50 deductible first. After, your insurance will pay for some of the remaining $200 balance. In this scenario, if it’s a minor service that’s covered 80%, then your insurance will pay that percentage of the leftover balance ($160).
You’ll be responsible for paying the remaining 20%, which is called your coinsurance, in addition to your deductible. So you’ll have to pay $90 out of pocket for that treatment, which is your $50 deductible and the 20% coinsurance of the remaining $200 for the treatment.
What’s the Difference Between a Family and Individual Deductible?
The way deductibles are structured can differ between individual and family dental insurance policies. For individual policies, they work similarly to the example above. If you have a $50 deductible, it applies only to you, and you have to pay that amount before you can enjoy your insurance benefits!
Family plans work a little differently. These plans have a family deductible that is split between members of your household into individual deductibles. You would have to pay that cumulative total before your family starts to get coverage.
For instance, if your family plan’s deductible is $200, this amount can be split between four family members, meaning each person may have an individual deductible of $50 (if it were divided evenly). Once the collective payments reach $200, you won’t need to pay any more deductibles for the rest of the year.
Are There Any Services Exempt from Deductibles?
To help encourage policyholders to be proactive with their oral health, many dental insurance plans will cover preventive services regardless of whether you have met your deductible. That means you can get your two checkups and cleanings a year without worrying about the cost! It’s always best to double-check your specific policy to find out if it waives your deductible for any services.
Even though dental insurance deductibles may have been hard to wrap your brain around at first, getting to know the ins and outs of your policy can help you get the most out of your benefits! Understanding this important part brings you one step closer to maximizing your coverage like a pro.
About the Practice
At Brooklyn City Dental, we want you to feel confident in using your dental insurance. Our front desk team is happy to help you understand your policy so you can get maximum coverage. We may be able to preauthorize you for certain services to help give you peace of mind. To see how we can help you navigate your dental benefits, visit our website or call us at (718) 725-7732.