4 reasons you may owe money out-of-pocket at the dentist

Visiting the dentist is an essential part of good oral health, but sometimes unexpected expenses come up even after your dental appointment. Understanding why these out-of-pocket costs happen can help you prepare for future visits and manage your budget effectively.

Reasons for out-of-pocket expenses after a dental appointment 

Here are four common causes of out-of-pocket expenses after a dental appointment:

Your dental plan has a deductible

Some dental plans may have deductibles that you must meet before your coverage kicks in. If you haven't met your deductible for the year, you may be responsible for covering the full out-of-pocket cost of certain dental services until the deductible is met.

Preventive care services like cleanings are often covered at 100 percent, even if your deductible hasn’t been met yet.

Sign into your member portal to see what your plan’s deductible is.

Your dental plan doesn’t fully cover the dental work you need

After your deductible is met, your plan will pay for a percentage of treatment costs. You, the member, may also be required to pay the remaining percentage after we pay our portion. This is known as coinsurance. Paying coinsurance will not start until you’ve met the required deductible, so you won’t be paying both at the same time.

For example, let’s say your dentist fills a cavity during an appointment. Typically, the necessary filling is covered at 50 percent. That means Delta Dental of South Dakota will pay half of the cost, while you will pay the remaining 50 percent out-of-pocket. The 50/50 split between you and Delta Dental of South Dakota is your coinsurance.

You hit your annual maximum and still have treatment scheduled in that plan year

Many dental plans have an annual maximum. This is the total dollar amount that Delta Dental of South Dakota will pay toward treatment during one plan year. For example, say your plan states that your annual maximum is $1,000, and in one plan year you had three restorative dental procedures that totaled $1,300. Because you exceeded your annual maximum by $300, you are responsible for paying that $300.

Many of our plans include our Prevention Pays feature, which means preventive services like exams, cleanings, and x-rays don’t count against your annual maximum. It gives you more benefits to use to pay for restorative treatments.

Once the plan year resets, your annual maximum does, too.

Your treatment isn’t covered by your plan

Dental coverage depends on your plan’s specific design, and not all plans cover all treatments!

If you want to have a special whitening treatment done or putting veneers on your teeth, these would likely be considered cosmetic services and be at your expense. Cosmetic dental procedures focus on improving the appearance of a person’s mouth rather than supporting oral health. Cosmetic services often aren’t covered by dental benefits plans, so you’d have to pay the total cost.

Delta Dental of South Dakota believes in preventive care

Delta Dental of South Dakota dental plans often cover 100 percent of routine preventive and diagnostic care. This includes procedures like cleanings, exams, and X-rays.

Why do we cover these procedures? We believe in the power of preventive care. When you maintain your preventive care appointments, you reduce your chances of needing expensive, restorative dental procedures in the future. This helps keep out-of-pocket costs to a minimum.

Click here to learn more about the benefits of preventive care.