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The Difference Between Annual Maximum and Deductible

Annual maximums and deductibles are both ways you help share the cost of dental care with your dental benefits company.

An annual maximum is the maximum dollar amount a dental benefit plan will pay toward the cost of dental care within a specific period, usually a calendar year. If your plan’s annual maximum is $1,000, your dental benefits company will pay its portion of your bill up to that amount for any covered dental services received in that year. After that annual maximum amount, it’s your responsibility to pay for any additional costs until your plan year starts over.

If your plan covers orthodontics, there is typically a separate maximum amount that your dental benefits provider will pay toward the cost of care of orthodontia. Check your plan for specific coverage limits.

Annual Maximum vs Deductible

A deductible is the total amount you have to pay before your dental benefits plan covers expenses. Let’s say you have a $100

deductible and need to get a crown. In this example, let’s assume you haven’t paid anything towards your deductible so far this year, and a crown costs $600. You’ll need to pay the first $100 of that cost out of your own pocket. After you’ve paid your $100 deductible, your dental benefits company will pay its share of the rest of the bill based on your coverage.

The deductible only has to be met once – not for each service. Usually, the deductible has to be paid once every plan year. In some plans the deductible only has to be paid once for as long as you are continuously enrolled in the plan. In either case, your benefits company will start paying its portion of covered services immediately after the deductible has been met.

Still have questions? Login and check your plan benefits online, or call us toll free at 1-877-841-1478 during regular business hours. We’re happy to help you understand your benefits!