What Is Dental Coinsurance and How Does It Work? | Delta Dental Of Washington

Along with dental insurance deductibles, coinsurance is one of the ways you and your dental insurance provider share costs. If your dental benefit plan covers less than 100% of the cost of a service, you are responsible for paying the remaining percentage directly to your dentist. this amount is what is known as your “coinsurance.”

But how exactly does coinsurance work and how is it different from a copay? We know insurance can be confusing, but we’re here to help shed some light.

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When you look at your summary of dental benefits, your coinsurance is usually listed as a percentage, or rather, you’ll see the percentage your insurance provider will pay for each service.

As shown in the following comparison chart of three individual delta dental plans, preventive care, fillings, crowns, root canals, non-surgical extractions, and deep cleaning for gum disease are covered between 50 and 100%.

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In the case of the premium plan, you will not pay anything more for preventive treatments. the plan then covers 80% of the fillings, which means you will be responsible for paying the remaining 20% ​​as coinsurance. You will also be responsible for 50% of the cost of crowns, root canals, non-surgical extractions and/or deep cleanings.

Please note that in many cases, you will need to pay your coinsurance in addition to your deductible. Your deductible is the annual dollar amount you pay directly to your dentist before your insurance begins to pay. deductibles typically range from $50 to $100, and you don’t have to pay any additional deductibles once you’ve met it for the year. In addition, many insurance providers, including Delta Dental, waive deductible payments for some or all preventive care.

To dig deeper into how coinsurance works along with the other pieces of the dental insurance puzzle, let’s use an example. Let’s say you need a cavity filled, which costs $300.* Your deductible for the year is $100, after which your plan will cover 80% of the cost of the fillings, leaving you the remaining 20%.

• • You will pay $100 up front, out of pocket, to your dentist. this will be deducted from the total cost of $300.
• • Of the $200 balance, your insurance will pay 80% = $160.
• • For coinsurance, you pay the remaining 20% ​​= $40.
• • Your $100 deductible + $40 coinsurance = a total of $140.
• • However, if you need to have a second cavity filled during the same calendar year, you will not have to pay any additional deductible because you have already met that deductible. in that case:
• • Of the total $300, your insurance will pay 80% = $240.
• • For coinsurance, you pay the remaining 20% ​​= $60 total out-of-pocket cost.

*These numbers are for example only. your total out-of-pocket cost will vary based on your provider, plan choice, age, and location.

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Your coinsurance for certain treatments may be as low as 10% or even nothing, while more complicated procedures may require you to pay 50% or more. each dental plan has its own breakdown by treatment, and what’s right for one person may not be right for another. When trying to decide which type of coinsurance is right for you, it’s important to consider your current financial situation and how much dental work you might need.

Typically, plans that have lower coinsurance (meaning they cost you less per treatment) will cost more in monthly premiums, while cheaper plans require you to pay a higher percentage of any procedures you receive. if you only anticipate needing basic cleanings and maybe an occasional filling, a lower premium/higher coinsurance plan may be your best option. But if you end up needing substantial dental work, a plan with a higher monthly premium could save you money in the long run.

Coinsurance and copays are out-of-pocket costs associated with dental insurance, but while coinsurance is based on a percentage of the total cost, copays are predetermined flat fees that you must pay before receiving any service or treatment. (For more information on copays, read our guide here.)

We cannot give a definitive answer as to whether coinsurance is better than copayment or vice versa, as it largely depends on each individual’s particular situation. That said, one benefit of the copay is that instead of being surprised by a higher-than-expected dental bill, he’ll always know exactly how much he’ll have to pay. however, this does not always end up saving you money in the end. Regardless of what a procedure actually costs, the flat fee is what he will pay, even if the coinsurance had been less.

Of course, understanding this difference is only part of making an informed decision about your plan. Premiums, deductibles, copays, and coinsurance may seem complicated, but a little research makes the process simpler. Click the Get Your Quote button below to start comparing policies.

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