Demystifying Dental Insurance Deductibles: What You Should Know

When don’t understand the jargon, an industry can seem mysterious or sneaky. The world of insurance is particularly challenging. When your dental team starts talking about your deductible and co-pay, you can quickly get lost. However, you need to understand these terms in order to use your insurance wisely. Here is essentially what you need to know about dental insurance deductibles so that your policy can work best for you!

A Dental Deductible Isn’t as Complicated as It May Seem.

Insurance lingo can be tricky to grasp, but an annual deductible basically is a certain dollar amount that you’re obligated to pay for covered services prior to your insurance coming in for its portion of the rest. As an easy example, if you receive treatment that is $350 and you have a $50 deductible, your coverage applies to the remaining $300. Assuming your procedure is 80 percent covered by insurance, your provider will pay $240, leaving you with a $60 bill. In total, your out-of-pocket expense is $110.

You May Have an Individual or Family Deductible.

Plans can vary from company to company, and even the same provider can offer various options. As a result, you may have an individual deductible, which means that each person in the policy must meet the required deductible, or a family deductible, which is a total amount that the group collectively will pay before benefits start.

Once Your Deductible Is Met for the Year, You Don’t Have to Pay It Again.

Unlike a co-pay, your deductible is a fixed amount you must pay before your coverage kicks in. When you meet it, your dental insurance will start to work to your benefit. For example, if you have a deductible of $50 for the year, and you’ve already paid this amount at a previous appointment, you only have to worry about your co-pay.

Your Deductible Most Likely Resets Every January 1.

Most dental insurance runs on a calendar year cycle, which means it is effective from January 1 to December 31. What if you start a new job halfway through the year? Your deductible may still reset when the next new year starts, so keep this timing in mind.

You Don’t Have to Figure Out Dental Insurance Alone.

If dental insurance is still confusing to you, don’t worry! You’re not alone in working with your policy. Your dentist’s team can assist you by answering basic questions and taking care of paperwork for you. They will let you know how much you owe and give you a breakdown of the costs with a more detailed explanation if you want one.

Hopefully, with this basic knowledge of deductibles, some of the mystery and confusion can be cleared up, and you can use your dental insurance to your advantage.

About the Practice

At Framingham Premier Dental, we are proud to be in-network with many dental insurance companies, including Delta Dental PPO, BlueCross BlueShield, Aetna, MetLife, and many more. We even accept MassHealth for kids! If you have questions about your policy or using your insurance with us, don’t hesitate to reach out to our team online or call us at 508-875-0900.