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Published: October 26, 2020

Understanding An Annual Maximum – What Are Your Dental Benefits

Do you know the status of your dental benefits? Unless you know how they work, you won’t be able to put them to good use. In order to get the most out of these benefits, the first thing you need to do is educate yourself on the topic.

This is where an “annual maximum” comes in. This is an important part of dental coverage and lets you know how much you can afford.

What Is an Annual Maximum?

Dental plans differ depending on the type you have signed up for. Every plan has an “annual maximum,” which is the amount of money a dental benefits provider offers. This money goes toward dental treatments that are done over a period of 12 months, which is collectively known as a “benefit period”.

Your benefit period can start any month. Let’s assume that right now, your benefit period is following the calendar year. Meaning ― your benefits will start in January and end in December.

So, if your annual maximum limit is $1,500 then your provider will make payments based on the plan’s coinsurance amounts until the entire amount has been given out. However, not every dental treatment will be covered. You dental plan’s details will outline the procedure of cost sharing.

As the new year will start, your annual maximum will automatically reset and a new benefits period will start.

Here’s an example to help you understand how annual maximum works:

Scenario: Your annual maximum is $1,500.

In January, you go for a dental checkup and the dentist says that you have a cavity that needs filling. The procedure’s cost is $100 and your plan is providing coverage for only 80% of it, which amounts to $80.

  • Remaining annual maximum: $1,500 - $80 = $1,420.

In March, you find out that you need a root canal that costs $700. Again, your plan covers only 80% of the procedure, which amounts to $560.

  • Remaining annual maximum: $1,420 - $560 = $860.

In October, the dentist recommends getting a crown. The procedure’s cost is $900 and your plan is providing coverage for only 50% of it, which amounts to $450.

  • Remaining annual maximum: $860 - $450 = $410.

You now have $410 in benefits, which can still be used for one more procedures. Once your annual maximums come to an end, the cost of all dental procedures will fall on you until the benefits are reset.

*The example mentioned above is purely for explanatory purposes. Kindly refer to your benefit booklet to find out your coverage.

IMPORTANT: Teeth cleanings also use your maximum. Many guests are confused by this, thinking that they get 2 cleanings per year no matter how much of their benefit is used. This is not necessarily the case based on your annual maximum.

Where will I find information about my plan’s specifics?

Visit your dental provider’s website and log in to your account. You will have access to the following information

  • Your dental plan’s annual maximum
  • Your benefit period
  • What percentage your dental provider covers for preventative and diagnostic, as well as minor and major services

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