Dental Insurance Deductibles 101: What You Should Know

Any type of insurance can be confusing — and dental insurance is no exception. As you are trying to figure out how to use your policy in the most advantageous way, you might come across some terms that you are unfamiliar with, such as “deductible.” What exactly is a dental insurance deductible, and how might this aspect of your policy affect your out-of-pocket cost for oral health services? This blog post explains what you should know.

What Is a Deductible?

Defined simply, a deductible is the amount of money that you have to pay before your dental coverage kicks in. Most typical dental insurance plans come with an annual deductible of $50 or so.

Here is an example of how deductibles work: Imagine that your dentist recommends a service that costs $300 total. Your insurance coverage rate is 80%, and your deductible is $50. You will pay your deductible, leaving a balance of $250. Your insurance will then pay 80% of that total, which amounts to $200. Your total out-of-pocket obligation will be $100.

Since deductibles work on a calendar year basis, you only have to worry about yours once a year. After you pay it, you can enjoy simpler, more straightforward coverage.

There Are Family and Individual Deductibles

If you are the only person on your dental plan, you just have an individual deductible. However, if your family members are also on your policy, things are a bit more complicated. Each person may have a deductible, and there is likely to be a family deductible as well. Usually, the family deductible is $150.

To help you understand things a bit more clearly, imagine that four people are on your policy: you, your spouse, and two minor children. If your family deductible is $150, each family member will be obligated to pay a $50 deductible, but only until the total $150 is met. For example, if you, your spouse, and one of your children all pay your individual deductibles, that will meet your family deductible. There should be no deductible for the remaining child.

The Deductible Is Waived for Some Services

It is common for dental insurance policies to completely cover the cost of preventive and diagnostic services, including cleanings, exams, and routine X-rays. Often, there is no deductible for such services; it might apply only to restorative care. Therefore, it is likely that you can attend your biannual cleanings and checkups without paying a dime out of pocket.

Still Have Questions?

Every dental insurance policy is unique, and it can be easy to get lost in the details. If you need help figuring out how your benefits work, ask your insurance company or your local dental team. They will be happy to serve you!

Meet the Practice

The four dentists at Scotch Plains Fanwood Dental care, along with our talented support staff, are proud to offer top-quality care at reasonable prices. We welcome many dental insurance plans, and we are always happy to help patients maximize their coverage. To learn more about how we may be able to serve your family, contact our office at 908-322-3222.