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Dean George is the Marketing Specialist and Content Creator for Dental Insurance
Store and its social media channels. He is a regular contributor to Agent Straight Talk, the
only consumer blog explaining the ins, outs and in-betweens of dental insurance and
discount dental plans. READ MORE

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Know the Difference between Copays and Deductibles?

Jan 04, 2012

Insurance gobbledygook is one of the most frustrating things about insurance. (That and those pesky premiums)  Would anyone be surprised if the origin of insurance jargon was traced back to a marathon Scrabble contest? Or maybe a spilled can of alphabet soup on a Ouija board? Is it even possible to understand insurance without having a law degree and a copy of Merriam-Webster?

Yes, it is. So pull up a chair, get comfortable and let's do dental!

A question we frequently receive at is the difference between ”copay" and a "deductible".  A copay is a fixed amount that you must pay for a dental procedure or visit. For example, some Dental Health Maintenance Organization (DHMO) plans require a $10 copay for every dental visit, regardless of the procedure. Routine exams or X-rays may be covered 100%, but you still have to pay the $10 office copay. DHMO plans are more likely to require copays than other types of dental plans.

A deductible is a fixed amount that you must spend out-of-pocket before your plan benefits begin. Many dental plans have a $50 annual deductible. In that case, if your first dental visit of the plan year costs $80, you must pay the $50 deductible first before the plan begins paying anything toward the remaining $30 balance. A few dental providers have lifetime deductibles, meaning that you only have to pay them one time, as opposed to annual deductibles. Most dental plans require annual deductibles, though.

Remember, not every dental plan has deductibles. Deductibles are usually associated with Preferred Provider Organization (PPO) and indemnity plans, whereas discount dental plans and DHMO's generally have no deductibles.

Congratulations! You now know the difference between copays and deductibles so remember to impress your friends and family with your newfound knowledge. Please visit again soon as we continue to shine the light on the nooks and crannies of confusing insurance terms.

If you have further questions about these insurance terms or others, email me

Contact me on Twitter@ToothTeller

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Copyright 2012, Bloom Insurance Agency, LLC ©

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