Deductibles, copay and coinsurance are all ways you share the costs of dental care with your benefits company – but they all operate a little differently.
A deductible is the total amount you pay before your dental benefits company helps with the costs. For example, if you have a $100 deductible and you need to get a crown that costs $618 you will need to pay $100 – your deductible — before your benefits company pays its portion of the remaining $518.
You generally only have to pay your deductible once every plan year, so after it’s been paid your coverage will kick in immediately if you need another dental service during the rest of the plan year. In some plans, however, the deductible only has to be paid once for as long as you are continuously enrolled in the plan.
Coinsurance is a percentage of the cost you pay for a dental treatment. If your coinsurance is 20 percent, then your dental plan will cover the other 80 percent of your dentist bill. A $100 service would cost you $20 out-of-pocket, while your dental plan would cover $80. If the service is $150, you pay $30 and your plan picks up $120. Coinsurance is usually due to your dentist at the time of the service, and you pay it even after you’ve paid your entire deductible.
Copay is a fixed dollar amount you pay for a covered service. Typically a copay is used only in a very limited type of dental plan so be sure to review your plan details. The copay amount doesn’t change no matter how much the dentist charges. If your copay is $20 and your dentist bill is $200, you’ll still pay just $20 while your dental plan picks up the rest. Your copay is usually due to your dentist at the time of the service, and you pay it even after your deductible is reached.
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!