What is a dental insurance annual maximum?
By Ann Marie Walker on January 14, 2022 in Dental benefit information
What is a dental insurance annual maximum?
An annual maximum is the maximum dollar amount your dental insurance will pay toward the cost of dental services and/or treatment in a benefit plan year, typically a 12-month period. Each time a dental claim is submitted, your dental insurance provider subtracts the cost that they have paid for the service from your maximum. Once the annual maximum is reached, any further dental services you receive are 100% your responsibility to pay until the next plan year.
Your annual maximum applies only to the portion your dental plan pays on your behalf. Any deductibles or co-pays that you pay do not count towards your annual maximum. Some important basic services, such as diagnostic and preventive procedures, might not count toward your annual maximum; however, this will depend on your specific dental plan.
An annual maximum usually ranges between $1,000 and $2,000 and resets at the end of each benefit period, typically 12 months. Certain plans could have an even higher annual maximum, so make sure to check with your dental insurance provider.
Does orthodontic care count towards the annual maximum?
Unlike most dental coverage, which renews its annual maximum each plan year, orthodontic benefits typically come with lifetime maximums. This means all orthodontic treatments within the same year or across multiple years will be counted against your total available orthodontic benefit. Your total orthodontic benefit will not renew at the beginning of each benefit period and once you have reached the orthodontic maximum, there is no further orthodontic benefit for the life of your dental plan.
What counts toward an annual maximum?
Examples of dental services that may count toward your dental coverage annual maximum include cavity fillings, root canals, crowns, extractions and other surgeries. Depending on your plan, services that are considered diagnostic or preventive, like exams and cleanings, may not count toward your annual maximum. If you have any questions about what services will count toward your dental insurance annual maximum, we recommend speaking to your dentist or dental coverage provider who will be able to provide greater detail.
How can I check what my annual maximum is?
There are a number of ways to check the remaining balance of your annual maximum. There is always the option of simply contacting your dental carrier’s customer service team to speak with a representative. However, nowadays, many dental benefits provider companies are using online dashboards to aid in this process. Customers are provided with a unique username and password and can go online to easily lookup their information like available plan benefits or how much of their annual maximum amount is remaining, without having to pick up the phone. If you are a Delta Dental of Illinois member, you can log in here and see how much benefit remains.
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1Your Dental Benefits: Use Them or Lose Them. (n.d.). Retrieved November 15, 2020, from https://www.mouthhealthy.org/en/dental-care-concerns/paying-for-dental-care/using-dental-benefits