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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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Dental Plan Shopping Tips 2

Jun 10, 2014

By Dean George

Last week we focused on two important considerations when shopping for a dental plan: waiting periods and effective dates. We presented just two last week to save space and with the hopes you’d drop by again. Thanks for stopping back by!

There are other important considerations too, so with the thought of making you all savvy dental plan shoppers, let’s look at deductibles and annual maximums.

DEDUCTIBLES Earlier this year we explained what a deductible is. Today we want to focus on why it’s important to know which dental plans have them and how that may affect your out-of-pocket costs during routine six-month dental visits.

Preferred Provider Organization (PPOs) plans generally have either an annual deductible or a lifetime deductible. They both work the same way except with an annual deductible, the plan member must spend a fixed amount out-of-pocket before enjoying their plan benefits every year. A lifetime deductible only requires a member to pay one time as long as they belong to the plan and maintain uninterrupted coverage.

Dental plan deductibles work like those in auto insurance or health insurance with one important caveat: dental plan deductibles are generally only $50, whereas auto insurance deductibles range from $250 to $500 to upwards of a $1,000.

Think that’s pricey? You should have a look at health insurance deductibles!  In 2014 family health insurance deductibles cost more than 4-year tuition costs at most public universities ($8,893 on average compared to the $10,386 average deductible for an Exchange Marketplace Bronze plan) and slightly less than the per capita income in China ($10,960). That said, a $50 annual deductible to help keep your mouth healthy seems like a pretty good deal, doesn't it?

ANNUAL MAXIMUMS As with deductibles and the waiting periods discussed last week, annual maximums are generally associated with PPOs. It’s important to note that the annual maximum does not refer to a limit that a member pays out of pocket, but rather the maximum the insurance plan will pay for dental treatment per year (Per year may be based on the anniversary date when a member joined, or the calendar year, depending upon the plan).

After 12-months, the meter resets and the plan will pay the full annual maximum for the next 12-month cycle.

Annual maximums typically range between $750 and $1,500 but most preventive care is included at little or no cost and doesn’t count against the annual limit. An annual maximum becomes an issue when you need a lot of dental work done within a 12-month period.

For example, let’s say you have a plan with an annual maximum of $750. Your dentist says you need a crown that will cost $800 and two dental fillings that will cost $130. The plan benefits say it will pay 50% on the crown and 80% on the fillings (if you use a network dentist).  Since the annual maximum is $750, if both the crown and fillings are obtained during the same 12-month period, the plan will pay $400 for the crown ($50%) and $104 on the fillings (80% of the $130 cost for two fillings.)

Because the plan has paid $504 for the year, subtracting that from the $750 maximum means the plan will pay no more than $246 toward any future eligible dental costs during the remainder of the 12-month period.  A margin like that may be an extra incentive to brush twice daily and floss regularly, but it also may lead to a few sleepless nights if sweets and sodas are part of your regular diet.

If you think you may need some major dental work, you may want to consider a PPO plan with a higher annual maximum. Other options may be a dental plan with no annual limit like a Health Maintenance Organization plan or a discount dental plan.

Thanks for reading Agent Straight-Talk, and for more dental tips, healthy teeth trends and oral health news, follow us on FacebookTwitterPinterestGoogle+, and LinkedIn!


Copyright 2014, Bloom Insurance Agency, LLC   

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