When You’ll Pay Out-of-Pocket
By focusing on preventive care, dental benefits are designed to save you money in the long run.
But even with coverage, there may be some dental care costs that won’t be reimbursed. Here are three scenarios where you may have an out-of-pocket dental expense:
1. You have not met your deductible.
A deductible is the amount you’ll pay for treatment before your provider helps cover the costs. Deductibles usually apply to basic or major treatment, not cleanings and exams.
2. Your procedure is partially covered.
After your deductible is met, coinsurance will take effect. This means your provider will pay for a percentage of covered treatment costs, and you will pay the remainder. Some treatments may also require a copayment to be paid before treatment is received.
3. Your treatment is not covered.
Dental coverage depends on your plan’s specific design, and not all plans cover all treatments. It’s important to know the details of your plan before your appointment so you’re not met with any surprises.
Also keep in mind that some dental plans have a yearly maximum dollar amount. If you’ve exceeded this annual maximum, you will be responsible for all treatment expenses, even if that treatment is normally covered.
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