With the end of the year right around the corner, it’s time to start thinking about utilizing any remaining dental insurance benefits you paid for in 2025 and selecting your plan for 2026. If you’re a little confused about what some of the terminology in your policy means, here are the definitions for four important concepts to understand about dental insurance!
Deductible
Your dental insurance deductible is the minimum amount to be paid before your insurance policy will cover your treatment. For example, if your deductible is $500 and your procedure is only $250, your insurance will not cover any of the procedure and you will owe the entire amount out of pocket.
Copays and Coinsurance
A copay is a set dollar amount that may be required during a procedure. Once you’ve met your deductible, most policies will only cover a percentage of the remaining cost. The balance that remains is referred to as coinsurance. This usually ranges between 20 percent and 80 percent of the total bill. Your plan will either have a copay or coinsurance, but not both. If you have an HMO plan, you will likely have a copay, while PPO plans will have coinsurance.
Annual Maximums
Unfortunately, most dental plans will cap how much they’ll pay for your dental procedures. Typically, maximums will range from $1,000 to $2,000 a year. A general rule of thumb is the higher your monthly premium, the higher your annual maximum. Once you have reached your yearly maximum, you are responsible for 100 percent of any remaining dental procedures, although some dental insurance plans may offer policies that allow you to roll over a portion of your unused annual maximum to the next year. Check with your individual plan to verify your coverage.
Remember, your dental insurance is designed to be preventive in nature, meaning that they pay more for annual exam and cleaning appointments than they will for restorative treatments like fillings or root canals. Thus, be sure to get the most of your coverage and your money and be sure to attend your regular, six-month appointments. This will also help protect your teeth and gums, reducing the need for costly repairs, saving you time, money, and of course, your beautiful smile!
About Dr. Patel
Are you looking for the best dentist in network with United Healthcare? Look no further than Dr. Hiren Patel. After graduating from the Government Dental College & Hospital in Ahmedabad, India, in 2006, Dr. Patel relocated to the United States, where he earned his dental doctorate from the University of Colorado School of Dental Medicine in 2011. Since that time, he has completed more than 500 hours of continuing education and holds memberships in such prestigious organizations as the American Dental Association, Academy of General Dentistry, and the Texas Dental Association, just to name a few. If you’re ready to make the most of your money and your smile, schedule a cleaning at HIC Dental by visiting our website or call 215-590-2736.