Dental Insurance Deductibles, Explained – Delta Dental Mass

A dental insurance deductible is the dollar amount you must pay for covered dental services before your dental plan begins to pay.

what is the annual dental insurance deductible?

Reading: What does annual deductible mean for dental insurance

A dental insurance deductible is the dollar amount you must pay for covered dental services before your dental plan begins to pay.

Your deductible amount resets once every 12 months. Many dental plan providers follow the calendar year (for example, January through December). check with your dental plan provider to confirm exact dates.

How exactly does the annual dental insurance deductible work?

There are two types of annual dental insurance deductibles:

individual annual deductible

When your dentist submits a claim for treatment, your deductible will be applied first, and coinsurance will be determined from there. For example, you receive a covered dental service that costs $250. your plan covers this service at 80%. If you have not yet met your deductible for the year, you will pay the $50 deductible, which will be applied to the charges for your dental services, before you receive coverage.

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Once you’ve paid the $50 deductible, there’s a balance of $200 left for the service. your remaining balance of $200 is 80% covered, so your insurance provider pays your dentist $160. that leaves you with the remaining balance of $40 to pay for the service received, plus the $50 deductible. As a result, your total out-of-pocket cost for the treatment is $90. if you receive additional treatment for covered services during that calendar year, then no additional individual deductible will be charged on your personal dental care.

Deductible calculation example

cost of the service

$250

your deductible

$50

amount covered by the plan: 80% of $200 (balance after meeting deductible)

$160

remaining balance

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$40

your total out-of-pocket cost (deductible + balance after plan coverage)

$90

annual family deductible

With a family plan, you will have a family deductible and each family member also has an individual deductible that feeds into the family deductible. So if you have a $200 family deductible and you have a family of 5, once you’ve paid four individual $50 deductibles, your family deductible is satisfied.

final thoughts

Depending on your dental plan, some dental services, such as preventive services, are covered in full and are not subject to a deductible. To promote good oral health, many plans will have no deductible for preventive services like annual exams, cleanings, or fluoride treatments. This is because these services help prevent and detect disease early and prevent more serious problems from developing.

additional resources

Looking for more information? learn more about the basics of dental insurance:

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