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Agent Straight-Talk

 


 

 

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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What the Deuce is a Dental Deductible?

Feb 11, 2020

By Dean George

One of the frequent questions asked of us at Dental Insurance Store is do our plans have deductibles? Some do, some don’t.

Next.


What exactly is a deductible and how does it work? To answer that we turned to our head librarian and lead researcher, Sherlock Tomes. Below is our Q & A with Mr. Tomes, or as his friends call him, Mr. T.

Q: What is a deductible and how does it work?

A: A deductible is a specific dollar amount a plan member pays before their insurance plan pays their portion. With most dental plans the deductible is usually $50, $100, or $150. Preventive treatments like oral exams and cleanings usually exclude having to meet a deductible.

Q: Are there different types of deductibles?

A: There are two types of deductibles: annual and lifetime. An annual deductible must be met each year, usually from January through December. A lifetime deductible is met just once and never has to be met again if continuous coverage is maintained.

Q: Why do some dental plans have deductibles and others don’t?

A: By including deductibles, dental plan carriers “ensure” (see what we did there?) plan members have a little skin in the game and will use their benefits responsibly. Dental plans with deductibles include Preferred Provider Organization (PPO) plans and Indemnity plans. HMOs and discount dental plans rarely have deductibles. The trade-off with the latter is you must stay within a network of dentists and specialists that accept those plans.

Q: What is the difference between a copay and a deductible?

A:  A copay is a fixed dollar or percentage amount you must pay for a dental procedure or visit. A deductible is a fixed dollar amount you must spend out-of-pocket before your plan benefits begin.

Q: How do deductibles work?

A: Mr. T. looked at me skeptically before asking, “I know you’re not a numbers guy. You sure you can handle this?”

“I think I can keep up, but slow down when you get to the numbers,” I shrugged.



“Okay, here goes,"Mr. T said. “You have a plan with a $50 annual deductible and go to the dentist for a routine exam and tooth cleaning which your plan covers at 80%. The bill is $125 for everything. How much do you pay out-of-pocket?”

“A nickel ninety-five?”

Mr. T gave me a look that would make B.A. Baracus from the 1980’s show The A-Team cower. Clearing my throat, I sat up straighter in my chair and tried calculating with my shoes on.

“Sixty-five dollars. Fifty dollars for the deductible, then 20 percent of the remaining $75 balance, which would be $15."

In the whiteboard of my mind it looked like this:

Me -$125 bill breakdown - $65 out-of-pocket ($50 annual deductible plus $15 copay [20%])

Great Teeth Insurance Plan - (Plan pays $60, or 80% of total bill, after deductible is met)

Mr. T. wasn’t exactly impressed, but his cocked eyebrow was all I needed to know that I would be spared a repeat of his death glare—at least temporarily.

Continuing with our story problem, he said, “On the second visit of the year, you have the same routine exam, but the dentist sees a cavity requiring a surface 2 filling at a cost of $76. Including another teeth cleaning, that brings your total for your second visit to $176. What’s your out-of-pocket costs?” he queried.

Focusing hard on my mental whiteboard, I realized that it really needed cleaning. I wondered if a little vinegar mixed with water would...

“Ahem,” Mr. T. cleared his throat and impatiently drummed his fingers on his desk, exhibiting all the patience of a spelling bee judge having been asked to use the words “donut” and “doughnut” in a sentence.

I’m going to say $35 and...20 cents,” I said, ignoring my sudden craving for a jelly-filled pastry.

My mental whiteboard looked like this:

$176 fee minus the 80% the Great Teeth Insurance Plan paid ($140.80) = $35.20 I pay.

I was right, of course, but Mr. T. expected no less. There would be no kudos, appreciation gift card or participation trophy today. I did get a second cocked eyebrow, though. Always leave them pleasantly surprised, Dad used to say.

To recap, a deductible is a fixed dollar amount a plan member must pay before their plan pays their share. Simple, right?

Thanks for reading Agent Straight-Talk and remember: “Use your smile to change the world; don’t let the world change your smile.” Full disclosure: following us on Facebook, Twitter, Pinterest and LinkedIn may give you something more to smile about.

Photo sources: Park and Associates, Inc., needcoffee.com


Copyright 2020, Bloom Insurance Agency, LLC©




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