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You may know about annual maximums – the most your dental plan will pay toward care in a 12-month period. But you may not have heard about lifetime maximums – the amount your dental plan will pay for care over the course of a lifetime.
Lifetime maximums rarely limit services like cleanings, regular checkups, fillings, crowns, root canals or periodontal treatments. Usually, they only apply to specific services such as orthodontic treatments.
For example, many plans will cover a fixed percent of orthodontic treatment in a plan year, up to an orthodontic lifetime maximum:
Cost of orthodontic treatment (braces) is $6,000
Dental plan covers 50% of orthodontics up to the lifetime maximum.
Orthodontic lifetime maximum: $1,500
In this example, your dental plan would cover $1,500 and you would be responsible for the remaining cost. In most cases, Delta Dental of South Dakota will make an initial payment of $1,000, with a second payment (if the plan’s orthodontic lifetime maximum is higher) made 12 months later as treatment progresses.
Lifetime maximums can sometimes be for the lifetime of that benefits plan only. If you or your employer switch benefits companies, the lifetime maximum may reset, or it may carry over.
Also, lifetime maximums typically don’t follow child dependents when they “outgrow” dependent coverage. Children may have a lifetime maximum as dependents under their parents’ dental plan, but usually receive new lifetime maximums when they become primary plan members as adults.
Some plans have lifetime maximums and others don’t. Review your plan coverage to find out: