Dental benefits work best when you know how to use them. The first step in achieving this is understanding what dental benefits do and how they work. Learn what the annual maximum is on a dental plan to get the most out of your dental coverage.
annual maximums on dental plans
Dental plans will vary depending on what you have signed up for. most dental plans have what is called an “annual maximum” or “annual maximum benefit.” This is the total amount of money the dental benefit provider, say Delta Dental, will pay for a member’s dental care within a 12-month period. that period of time is called a benefit period.
Reading: What is annual maximum for dental insurance
See also: How Much Does Shoulder Surgery Cost? – Dr. Chris Jones Colorado Springs, CO
A benefit period can start at different times of the year. for now, we’ll assume your plan’s benefit period is the calendar year. that would mean the annual maximum for your plan year applies from January to December.
If your plan’s annual maximum is $1,500, your dental benefit provider will pay its share of your dental work based on your plan’s coverage/coinsurance amounts, up to a total of $1,500 paid. your plan details will explain if a procedure has cost sharing. Your dental plan annual maximum resets at the beginning of each benefit period.
Please note that depending on your dental plan, services that are considered diagnostic or preventive may not count toward your annual maximum.
See also: How Much Does a Mammogram Cost in 2021? | Mira
The annual maximum on a dental plan is often confused with the term “out-of-pocket maximum.” The annual maximum refers to the maximum amount that the provider of dental benefits such as delta dental will pay in a plan year. instead, “out-of-pocket maximum” refers to the most you, the member, will pay in a plan year.
This is an example of how a dental plan annual maximum* works:
- Your plan has an annual maximum of $1,500.
- Your dentist says you need a cavity filling in January. the cost of that procedure is $100, her plan covers fillings at 80%, so her dental plan pays $80. (That’s $80 subtracted from your annual maximum for the year: $1,420 left)
- so in March you need to have a root canal, which costs $700. your plan covers root canals at 80%, which means your dental plan pays $560. (Your dental plan has now paid $640 for your dental care this benefit period of your $1,500 annual maximum: $860 remaining)
- In October, you need a crown, which costs $900. your dental plan covers crowns at 50%, which means your dental plan would pay $450. (In this example, you have used $1,090 of your $1,500 annual maximum: remaining $410 that can still be used during your benefit period)
- If you reach your annual maximum for your benefit period, which means Delta Dental has paid $1,500 for your dental services, any subsequent services are 100% your responsibility until the next benefit period.
- At the end of your benefit period, your annual maximum resets to $1,500.
- your benefit period
- your plan’s yearly maximum
- what percentage does delta dental cover for diagnostic services & preventive, basic and major services.
*example is for illustrative purposes only. Please refer to your benefit booklet for specific information about your plan coverage.
How do I find the details of my plan?
Log in to your member account to find your benefit information at:
See also: When Out-of-Network Care Can be Covered In Network | FAIR Health