Dental Benefits Explained | What is an annual maximum

You’ll get more out of your dental benefits when you know how to put them to use. The first step is understanding what they do and how they work.

Let’s start with an explanation of ‘annual maximum’ – a common term that affects how much you may have to pay out-of-pocket during each year of your dental plan.  Knowing the annual maximum on a dental plan will help you make the most of your dental coverage.

What are annual maximums in dental plans?

Dental plans will differ depending on each plan’s specific coverage, but most dental plans have what is called an “annual maximum.”

An annual maximum is the total dollar amount a dental plan will pay toward the cost of dental care within a specific time period. The time period is usually a calendar year, and is called a “plan year,” benefit year” or “coverage year.” However, the period can start at different points of the year.

If your plan’s annual maximum is $1,000, your dental benefits provider will pay for their portion of dental work until they pay out a total of $1,000. After that annual maximum amount, it’s your responsibility to pay for any additional costs until your next plan year. The annual maximum on your dental plan resets each plan year.  

Depending on your dental plan, services that are considered diagnostic or preventive may not count toward your annual maximum.

The annual maximum in a dental plan can be confused with the “lifetime maximum” or “deductible.” Now you’ll the difference!

How do annual maximums work?

Here’s one example of how your dental plan’s annual maximum could come into play:

  • Your plan has an annual maximum of $1,000. 
  • Your dentist says you need a crown. The cost for that procedure is $800. 
  • Consider the details of your dental plan. After logging into your account, you note your plan splits the cost of a crown 50/50 between you and Delta Dental.
  • If we divide the $800 crown procedure in half, $400 is your responsibility and $400 is Delta Dental’s responsibility. 

In this example, since the dental benefits provider paid $400 toward this crown procedure, they will still pay $600 toward your future dental procedures in that plan year.

Log into your member portal today to learn your plan year, annual maximum, and what percentage of cost is covered for various dental services.

Interested in understanding even more terms you’ll find in your dental benefits? See more explanations in our online glossary.