Your dental insurance plan can make it easier to afford important oral care. However, using your coverage might be intimidating, especially when you run into terms that you are unfamiliar with. For example, it is perfectly understandable if you are a bit unclear on deductibles! What exactly are deductible for dental insurance, and how do they work? This blog post explains everything you should know.
What Is a Deductible?
A deductible is the amount of money you are required to pay out of pocket for dental services before your insurance plan begins to cover costs. Deductibles are typically applied on an annual basis, meaning that once you have met your deductible within a calendar year, you will not have to worry about it again until your benefits reset in the new year.
Here is an example of how deductibles work:
If your deductible is $50, and you need a dental service that costs $300, you must pay your entire deductible. Then, your insurance will pay a portion of the remaining balance. In the cases of minor services that are 80% covered, your insurance would pay $200, leaving you with a 20% coinsurance of $50. Your total out-of-pocket obligation would amount to $100.
Family vs. Individual Deductibles
Dental insurance policies can differ in how they structure deductibles for individuals and families. If you have an individual policy, the deductible only applies to you. For instance, you might have a $50 deductible that you must pay before your plan begins to cover costs. Once you surpass this threshold, you can enjoy the benefits of your insurance.
Family plans, on the other hand, operate differently. These plans often have both individual and family deductibles. A family deductible is the combined amount that all members of your household must pay before the plan starts covering the costs for everyone. For example, if your family plan has a $150 deductible, this amount could be spread across three family members, each of whom has an individual deductible of $50. Once the cumulative payments reach $150, no more deductibles are required from your family for the rest of the year.
Are Any Services Exempt from Deductibles?
Many insurance plans exempt certain services from deductibles in order to encourage policyholders to be proactive about their oral health. For example, exams, professional cleanings, and X-rays are commonly covered without any deductible. Check your specific policy to find out whether it waives the deductible for any services.
Dental insurance deductibles might be confusing at first, but once you grasp the basics, you are well on your way to being able to use your policy like a pro!
Meet the Practice
Dr. Adriana Zaharie and the team at Villagio Family & Cosmetic Dental in Cinco Ranch, Katy, are proud to provide a range of services in our comfortable and welcoming office. We are happy to work with most dental insurance plans. To find out how we can help you use your benefits, contact us at 281-395-2100.