Maximums and Deductibles


Shopping for dental or vision insurance on your own can be daunting, especially if you come across terms that you aren’t familiar with. A couple of examples are maximums and deductibles. What do these terms mean, and how do they factor into your out-of-pocket costs?   

What is a dental insurance deductible?

Here’s a basic insurance deductible definition: this is the amount of money that you’ll be required to pay annually before certain types of coverage will kick in. 

As you work on calculating how much dental insurance will cost, remember to include the deductible along with the premium. However, unlike a premium, which is what you pay to be enrolled in a plan, a deductible is paid towards professional care in the dentist’s chair. 
Here’s an example: if you sign up for a plan that has an annual $200 deductible, certain types of dental care won’t be covered by the insurance until you meet that deductible. How do you meet it? Well, whenever you see your dentist for treatments that aren’t immediately covered, you’ll need to pay for them out-of-pocket. But, once you spend the $200, your insurance will take over and help pay for future treatments. 

Note: Once a new year starts on your plan, your deductible will reset. 

How do insurance deductibles work if you have a family dental plan?

If you’re planning on signing up for a policy that will cover your whole family, read the details to learn about the deductible. You’ll likely find that there’s an individual deductible, along with a family deductible. It’s a little more complicated, but once you get the hang of things, it’ll make sense. 

As individual members of your family receive dental care, and pay towards their individual deductibles, that money will also be applied to the family deductible. Then, once the family deductible is reached, deductibles will no longer apply for anyone, and your insurance will provide the additional coverage.  

Here’s an example: if your household of four has a family deductible of $200 and an individual deductible of $100, if two members of the household meet their individual deductibles, the family deductible will also be met. Remember: Before the family deductible is met, if an individual deductible is fulfilled, that person will receive the additional coverage, while other members will still need to pay towards their individual deductibles. However, once the family deductible is met, everyone in the family, regardless of whether or not they met their individual deductibles, will reap the benefits of the extra coverage.

Does all dental work count towards the deductible?

The answer to this question depends on the plan that you sign up for. 

With some plans, you might be able to receive certain types of care by paying a copay at each visit, without needing to worry about a deductible. Also, many plans will cover preventive care at 100%. On the other hand, you might find that restorative treatments, such as crowns, will only be covered after you’ve met the deductible. 

Knowing which out-of-pocket payments count towards the deductible will give you a better idea of how much you’ll need to budget. For example, if you need a treatment within a category of care that comes with a copay, it may or may not count towards the deductible. 
Are there plans with no dental insurance deductible?

Yes, you might be able to find plans that don’t have a deductible! A DHMO may not have a deductible to worry about, while a DPPO usually has one. 

Deductibles vary from one plan to the next as well, so you can search for policies that have the lowest deductibles if that’s what you’d prefer. 

What is a dental annual maximum?

A dental insurance annual maximum refers to the amount of money that the provider will pay in a year to help cover the cost of care you receive. This, too, will vary from one plan to the next. 

If you’re the type of person who typically needs a lot of expensive care, opting for a plan with a higher annual maximum can help you save more money. 

Example: a plan that has an annual maximum of $5,000 will pay out that much money before you’ll be responsible for any additional treatments you need.   

Once your plan renews at the start of a new year of coverage, the annual maximum will be reset. 

What should you do when you max out your dental insurance?

The good news is that many people don’t end up hitting the annual max on their dental plans. However, if you do, you’ll be responsible for any care you receive from that point forward, until the plan renews the following year.  

If you’re concerned about being able to pay for care totally out-of-pocket, talk to your dentist. You might be able to hold off on receiving treatment until your plan renews and the annual maximum resets. Or, you might be able to schedule treatments in a way that will help you avoid hitting the annual max.   

Does vision insurance have a deductible?

In many cases, you won’t need to worry about a vision insurance deductible. Most plans don’t include this cost. However, you may have other expenses, such as copays, and there might be an annual maximum too.


Use the Direct Benefits Marketplace to shop for dental and vision plans

Looking at all of the details that make dental and vision plans unique can be tedious. That’s why the Direct Benefits Marketplace makes it simple to browse and compare policies, whether you’re searching for dental insurance with no waiting period and no maximum or vision insurance with no deductible.