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What is a dental insurance annual maximum?

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 insurance 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 insurance 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 insurance 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 insurance 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 calling your dental insurance provider’s customer service team to speak with a representative. However, nowadays, many dental insurance companies are utilizing online dashboards to aid in this process. Customers are provided with a unique username and password and can go online to easily lookup insurance 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 subscriber of Delta Dental, then you can log in here and see how much benefit remains.

Below is an example of a chart showing how much of the annual maximum is left for the remainder of the benefit year.

My benefits and plan overview. Graph showing the annual maximum for an individual of $1,219 remaining of $1,300 My benefits and plan overview. Graph showing the annual maximum for an individual of $1,219 remaining of $1,300 My benefits and plan overview. Graph showing the annual maximum for an individual of $1,219 remaining of $1,300

Additional resources

Looking for more information? Learn more about dental insurance 101:

 

Sources:

1. Your 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