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What Does Annual Maximum Mean For Dental Insurance

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Are Health Insurance Premiums Tax

Health insurance premiums as well as dental insurance premiums can count as a tax-deductible medical expense if you itemize your deductions. However, you can only deduct medical expenses after they exceed 7.5% of your income². Consult your tax, legal, or accounting professional regarding your individual situation.

Whats The Difference Between An Epo And A Ppo Dental Plan

Michigan Health Insurance Customer Service Dental Plans For example, dental plans have an annual benefit maximum. See How do I find a dentist?

carry-over a portion of their annual maximum from one year to the next if their annual dental claims Compare carry-over benefits as some dental plans do Definition. The maximum amount your dental plan pays for covered services each 

The Insurance Company Likes You Better

An insurance company will reimburse you, as the patient, faster than it will reimburse the dental practice. YOU are their customer, after all, NOT the practice. So if you are in a situation where you have to pay the provider in full, the insurance company will reimburse you directly. Now withelectronic submissions, the reimbursement can happen within 2-4 weeks.

Even though we recommend you verify your own benefits, a reputable practice will help you figure this out. We will submit your insurance paperwork, and give you an instruction sheet on the next steps to submit or receive reimbursement. Our practice guides the patient through the insurance process until the reimbursement happens, and we are happy to help you with any claim issues along the way.

If youve been told you need a dental work, contact us at 704-243-1122 for an evaluation, as early as possible. Our office will break down that coverage for you so you can get an idea of what you have to use toward treatment.

  • Waxhaw Dental Center

What Is A Dental Insurance Annual Maximum

Annual maximums are the most feared and misunderstood of all dental insurance costs. They sound scary, but they arent actually.Sometimes referred to as a plan maximum, or maximum amount – a dental annual maximum is the total your dental plan will pay toward your care during any one plan year. Annual maximums usually range between $1,000 and $2,000. Nobody wants to max out on their dental benefits. But in reality, most people never reach their dental insurance annual maximum. According to the National Association of Dental Plans, only 2.8% of people on a PPO plan reach their dental annual maximum each year. Lets look closer at the concept and reality of dental annual maximums.

What Types Of Services And Treatment Does A Full Coverage Dental Plan Cover

Guide to Your Orthodontic Lifetime Maximum

The services and treatments covered under a full coverage dental plan depends on the type of dental plan you choose.

Typically, full coverage plans go beyond preventive care. They may also offer coverage for the following:

  • Basic restorative care: This usually includes things like fillings, extractions, and non-routine X-rays.
  • Major restorative care: This includes things like bridges, crowns, and dentures.
  • Orthodontic treatment: This includes things like space maintainers, braces, and other devices used to align your teeth.
  • Preventive dental care: This includes regular teeth cleanings, routine X-rays, fluoride treatments and sealants as indicated by age and frequency. Many dental plans cover 100% for preventive dental services with the exception of a copay at the time of the visit.

When choosing a full coverage dental plan, read the details carefully. Dental plans can vary even between insurers.

Annual Maximum Vs Out

All ACA-compliant health insurance policies come with an out-of-pocket maximum that limits the amount a consumer has to spend each year. A $1,000 out-of-pocket maximum means that once the policyholder has spent $1,000 in copays, deductibles and coinsurance, the insurer will pick up all additional costs.

In contrast, adult dental insurance both pre- and post-ACA come with an annual maximum, also known as a benefits cap. This instead limits the maximum amount the insurer has to pay in costs. A plan with a $1,000 annual maximum means that once the insurer has paid out $1,000 in benefits, the consumer is responsible for all costs. This is the exact opposite of how the out-of-pocket maximums work.

Applying Tax Credits For Dental Insurance

Any leftover tax credit not used to pay for your familys health insurance purchased through may be applied to pediatric dental insurance premiums if your medical insurance policy does not include dental coverage. If your health insurance policy includes childrens dental coverage, you cannot use tax credits to buy an additional plan.

What’s The Cost For Full Coverage Dental Insurance

Full coverage dental plans vary in cost depending on what type of plan you choose. For example, DPPO and DHMO plans may offer coverage for many types of dental services, but their costs can be quite different.

  • Deductible: This is what you pay before your plan begins to pay. Some dental plans have deductibles, such as DPPO plans. While many DHMO plans do not.
  • Coinsurance: This is the percentage of costs you and your plan share, typically once youve met your deductible. If your plan doesnt have a deductible, like a DHMO, you will pay a flat fee for the services you receive.
  • Annual Maximum: This is how much your plan agrees to pay toward your dental care in a plan year. If you go over this amount, you may be responsible for the out-of-pocket costs.
  • Premium: This is what you pay monthly for your plan. Some plans, like DPPOs, tend to have a little higher premium because they offer you a lot of choice. DHMOs tend to have lower premiums because you are more limited.

Most Affordable: Delta Dental

Delta Dental is a great pick when it comes to affordability, thanks to low starting prices and plenty of policy extras to help you save.  

  • Annual upfront premiums

Delta Dental is our pick for the most affordable policies, offering affordable dental discount plans that are further boosted by limited premiums and free service for many everyday procedures. It is a provider known for discount dental plans like its Delta Dental Patient Direct and DeltaCare® USA, plans that both prioritize affordability with low premiums. Prices vary by state and number of members to be covered. Delta Dental offers an upfront fee schedule for each of its plans, so you know exactly what you will need to pay, depending on the service you need.

There is generally no waiting period for preventive care, with coverage kicking in from day one, but some more in-depth procedures may require some form of waiting period. Either way, it is always important to check your coverage to see what is included with your specific plan. Delta Dental has a smaller network of dentists compared to some of the other providers, which means that you will have to pay out-of-pocket for any provider services that are outside of your network. If you do not mind sticking to Delta Dentals network, however, this could be a great choice for those who prioritize affordability for your dental plan.

What Is An Insurance Deductible

A dental insurance deductible is the amount you must pay out of pocket each year before your plan starts to pay for covered dental treatment costs. Its usually a specific dollar amount. For example, if your deductible is $100, your plan kicks in once youve paid that much in related dental care expenses. If youve used or purchased other types of insurance, chances are youve dealt with insurance deductibles before. No matter the type of insurance, deductibles usually behave the same way. An insurance deductible is the amount you pay out-of-pocket when you make an insurance claim before your benefits kick in. 

Consider A Dental Savings Plan

Dental discount plans enable you to save 10%-60% on your dental care. There are plans that cover all treatments from braces to dentures. There are no annual spending caps, waiting periods, approval process or restrictions on pre-existing conditions.

Dental savings plans are very affordable. The plans available on range from $79.95-$199.95 annually. Plus, many of dental savings plans include additional free bonus benefits too, such as savings on vision and hearing care, prescriptions, and other wellness services. Select plans even include a bundle of health and wellness services which range from telemedicine free consultations with local doctors who can diagnose and treat common ailments , discounts on chiropractic, alternative medicine and fitness centers, and savings on lab work and medical diagnostic services.

Visit to find out about how dental savings plans can help make quality dental care affordable.


Dental Information Center

How Much Do Dental Insurance Plans With No Annual Maximum Cost

Pricing for dental insurance depends on several factors, such as your age, gender, and the plan that you choose. For example, while Physicians Mutuals plans begin around $30 per month, Careingtons plans start as low as $8.95 per month. Plans with additional features like deductibles, copays, and waiting periods can all impact price, so carefully consider what features are most important to you. An insurance agent can also help you review policy options so you can be sure to find the best dental insurance plan with no annual maximum cost for you. 

How Dental Annual Maximums Work

Guide to Your Orthodontic Lifetime Maximum

Its pretty simple, really. At the start of each benefit period the maximum is set to pay for your dental care. Your annual maximum only applies to the portion your dental insurance plan pays on your behalf.

  • Your deductible doesnt apply to the annual maximum.
  • Any copays on your plan dont apply to the annual maximum.
  • Costs that accumulate after your deductible and copy are satisfied are applied to your annual maximum.
  • Most treatments have a coinsurance level; i.e., we pay XX% and you pay the rest. The original XX% is applied to your annual maximum.

Best Dental Insurance Plans With No Annual Maximum Of 2021

Physicians Mutual strikes an attractive deal with expanded coverage, no deductibles, and no waiting period for preventive care.

  • Coverage for over 350 procedures

  • No deductibles

  • No waiting period for preventative

  • 12-month waiting period for major dental

  • Limited coverage for some procedures

Physicians Mutual is our pick for best overall dental insurance plan with no annual maximum because of its multifaceted coverage and no waiting period for preventive car. Plans with Physicians Mutual start at around $30 per month for its basic plan, and coverage can include more than 350 procedures, which includes not only your preventive care but also more serious dental needs like crowns and dentures. Even better, there is no waiting period for preventive care, so you can get started right away on cleanings, x-rays, and routine exams.

How To Maximize Dental Coinsurance

Most dental insurance plans place an emphasis on preventive care. You may find your plan pays 80% or more for cleanings, exams, and X-rays twice each year.  If you need more extensive treatment, consider a phased plan that takes advantage of multiple insurance benefit years. For example, if you start treatment in the second half of the year and you know the annual maximum will renew in January, you could take advantage of two benefit years within a few months.

Are Lifetime Maximum Benefits A Concern

You should always become familiar with the policy limits and exclusions of your health insurance policy. Lifetime or annual maximum benefits are a concern for every policyholder because they mark the point when your insurance stops paying for medical services and directs the costs to you.

The definition of essential services and the role the ACA played in helping people with health insurance get fair and adequate protection has changed the level of concern.

Access to essential services with no limits greatly improves the quality of life and benefits insured people have. The ACA reduced consumers’ concerns for lifetime maximum benefits because it no longer applies to essential services.

While it is unlikely, the ACA can always be amended or replaced. If it is, insurance companies might again be able to enforce the maximum benefit limits for all services. It is important to be concerned about maximum benefits because if they are brought back, they can put your health and finances at risk as you age or are severely injured.

Do You Save Money With Dental Insurance Plans With No Annual Maximum

When there is not an annual maximum tied to your dental plan, you are able to receive an unlimited amount of coverage unless your plan stipulates otherwise. The monthly premiums may cost a bit more than your average dental plan, but you could save thousands in the long-term through discounted services and copays. 

Does The Affordable Care Act Cover Dental

No, the ACA, also known as Obamacare, does not cover dental coverage for adults. You will not face a tax penalty for not having dental insurance. However, the Affordable Care Act does mandate that dental insurance be made available to you if you have children, though you arent required to buy coverage for yourself as an adult.

Do All Dental Insurance Plans Have Deductibles

Not all dental insurance plans have deductibles. There are two main types of dental insurance plans, Dental Preferred Provider Organizations and Dental Health Maintenance Organizations . 

DPPO plans typically have deductibles, along with higher out-of-pocket costs overall. The main advantage of DPPOs is that they allow you to visit nearly any dentist without a referral and still receive full or partial coverage for the services.

DHMO plans do not have deductibles and typically have lower premiums. As long as you stay in your network, your co-payment will be your only additional out-of-pocket cost. However, DHMO plans typically encourage you to visit the dentists in your network to receive full coverage.

What Is A Plan Year Maximum

An annual maximum is the maximum dollar amount a dental benefit plan will pay toward the cost of dental care within a specific period, usually a calendar year. If your plans annual maximum is $1,000, your carrier will pay its portion of your bill up to that amount for any covered dental services received in that year.

No Annual Maximum Dental Insurance

Dental Insurance

Full coverage dental insurance plans do exist with no annual maximum benefit limits. You cannot find anything higher than unlimited. If your dentist is recommending a significant treatment protocol, this may sound appealing until you discover the caveats.

The carriers are in business to make money. They want to offer plans with affordable premiums that exceed what they must pay in claims. How do they do it? They limit networks or introduce disincentives such as copayments, or offer discounts rather than true insurance.

What To Do When Your Dental Insurance Is Maxed Out


Your dentist just told you that you need a root canal and a crown. No worries, you figure, youve got dental insurance. But wait youre not covered? Why? Because youve hit your annual cap.

That cap is the annual maximum coverage provided by your plan. Bizarrely, dental insurance policies generally limit coverage to $1000 -$1,500 a year a rate that hasnt changed for about forty years. To put that in perspective, back in 1970 $1,000.00 gave you the buying power of $6,273.87 in 2016.

The average cost for a crown these days is $750-$2000 per tooth, and the cost of a root canal is $750-$1,000+ per tooth . Obviously you can exhaust your annual dental coverage of $1000-$1500 fairly quickly. And when your dental costs for most procedures go over that limit, you then have to pay for your own dental care out of pocket for the rest of the year.

We Know Dental Insurance Terms Can Be Tricky To Understand We’ve Put Together This Handy Guide To Help You Understand Your Dental Insurance Coverage

Getting a handle on your dental insurance is step #1 to guarantee you get the maximum benefit from your dental coverage.

  • Read and review the benefits booklet for the fully detailed outline of all that is included in your dental benefits.
  • Register/sign in to your MySmile® account and click on Coverage overview for an easy-to-read overview of your plan’s features and benefits.
  • Benefit period
  • Reimbursement levels
  • Waiting period

To help you better understand these fundamentals of your dental coverage, here’s a brief explanation of each one:

Benefit PeriodEssentially, a benefit period is the length of time during which the benefit is paid. Your dental coverage has both a plan effective date, and an end date, and in most cases, the benefit period for your plan will be one year.So, if your effective date on your plan is January 1, 2020, and the end date is December 31, 2020, you will no longer have coverage as of December 31, 2020, unless you renew your plan before the end date.


These two terms may sound similar, but they are not exactly the same. Both are fees that the patient is responsible to pay for a portion of their dental treatments.

MaximumYour dental plan probably mentions two types of maximums: annual and lifetime.



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Selecting A Dental Insurance Plan

There are a lot of factors to consider when buying a dental insurance plan. What is covered by each type of plan, the monthly cost of premiums, the cost of the deductible and copay fees are all important factors when choosing an insurance plan that will fit your budget and your life. 

This is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist’s office.

Best For Major Dental Work: Careington

Careington C500 Dental Savings Plan

  • No. Policy Types: 4

Careington focuses on multi-faceted dental discount coverage with savings of up to 60% to help with your major dental work.

  • Starting at $9 per month

  • DialCare teledentistry option

  • Not available in Vermont or Washington

  • Limited orthodontic coverage

  • Copays still required

Careington is prepared to help with your major dental work, offering discount dental plans with an upfront fee schedule that makes it easy to understand your coverage. There are no eligibility exclusions, although plans are not available in Vermont or Washington. Plans start at about $8.95 per month or $89 per year with member savings of up to 60% off standard dental procedures. In addition to overall affordability, Careingtons coverage is comprehensive with no waiting period and includes cosmetic services like braces, dentures and teeth whitening. Limited orthodontic coverage is available.

Careington also offers DialCare Teledentistry, which offers a revolutionary new way to communicate with experienced and licensed dental providers. There is 24/7 support available 365 days a year via virtual consultations done over the phone or video chat. You can receive advice and even a diagnosis for everyday and urgent dental-related issues.

How Do Dental Insurance Deductibles Work On Family Plans

Family dental insurance plans typically involve both an individual deductible and a family deductible. In this case, the individual deductible applies per person only until the family deductible is exhausted. 

For example, lets say your family plans individual deductible is $50 and the family deductible is $100. Once the first two family members reach their individual $50 deductible, the family deductible of $100 is reached. They and any additional covered family members who seek treatment wont have any further deductible requirements for a calendar year.

Glossary Commonly Used Dental Insurance Terms

Over time, we have found the process of using dental insurance or dental benefits can intimidate patients.  We have put together this glossary of common insurance terms to help our patients better understand how their dental benefits work and the reimbursement process.  If you hear our staff use a term that you do not understand, feel free to ask them to explain.  Knowledge is power and Day & Night Family Dental wants you to get the most out of your hard earned dental benefits.

 |  |  |  |  | F | G | H |  | J | K |  |  | N |  |  | Q | R |  |  |  | V |  | X | Y | Z

Dental Plan Details On Healthcaregov May Be Misleading For Adults

This, however, is not the case when it comes to adult coverage. Fewer than 1% of all the health insurance plans on the exchange include adult dental as part of the package, leaving consumers to purchase standalone dental coverage. Adult plans have annual maximums which, despite sounding similar to out-of-pocket maximums, work very differently.

The problem is that both the anonymous shopping tool and the actual enrollment functionality of the exchange fail to call out these differences to the consumer, and in some cases label both as out-of-pocket maximums.

What Does Annual Benefit Maximum Mean In My Dental Insurance Policy

Donât Leave Money In Your Account

July 22, 2009 in Uncategorized | Tags: annual benefit maximum, Carolina Dental Insurance, Carrboro, Chapel Hill, Chip Millard, dental insurance, dentist, Durham, Hillsborough, North Carolina

All dental insurance plans refer to an Annual Benefit Maximum in their summary of benefits.  Sometimes this is also called Annual Plan Maximum, or Annual Maximum.  What does this mean.

The Annual Benefit Maximum of a dental insurance plan is the most benefit in terms of dollar amount you will receive in the policy year of your policy.  The majority of dental insurance plans offer a $1,000 Annual Benefit Maximum.  Thus, $1,000 is the most benefit you could hope to receive from the dental insurance plan.

The Annual Benefit Maximum is not based on the total amount of the dental services you receive, but on the total amount of benefit the dental insurance company pays out on those services.  Lets use a simple example to make this point clear:

I visit the dentist in 2009 three times,

Visit 1, an exam and cleaning, total bill, $150.

Visit 2, a root canal, total bill, $850.

Visit 3, an exam and cleaning, total bill, $150.

Protection For When You Need It Most

Medical insurance has a reputation for being overly complicated. Depending on the type of services, you might have to pay out-of-pocket until your deductible has been met. And, since we’re all trying to avoid a catastrophic injury, that would meet said deductible, we rarely see providers paying out.

With Spirit Dental Insurance or with other insurances, you will still have a deductible that will vary by provider, but the real catch is knowing in advance what your calendar year annual maximum coverage amount will be. Most insurance providers put a cap on the calendar year at $1,000 to $1,500, which might not be enough to fully protect you and your loved ones.

Dental Insurance With No Annual Maximum Benefit

If your teeth need plenty of work, full coverage dental insurance without an annual maximum benefit might seem like the best choice at least on the surface.

Insurance traditionally protects members from unexpected, extraordinarily high expenses. However, most dental plans work in the opposite fashion.

They cover routine work but cap what they pay in any calendar year. A dental plan with a very high or no annual maximum either costs much more or takes away something of value. Look under the hood of these options before making a purchase.

Avoid running out of benefits in a given year if you can. The alternatives are costly.

Best For Seniors: Guardian Direct


Guardian Direct is a veteran-focused provider that serves the senior community with specially curated plans that does not have any deductibles, waiting periods, or copays for routine care. 

  • No coverage for implants

Guardian Direct is our pick for best seniors with affordable pricing, quick enrollment, and dental insurance coverage that places a specific focus on veteran-friendly services. With Guardian Direct, plans start at $20 per month with easy online quotes and enrollment, plus there is extra peace of mind with the ability to terminate your coverage at any time. Guardian Direct is also an insurance provider that specializes in dental coverage for military veterans who do not qualify for dental care through Veterans Affairs.

To get started with Guardian Direct, you must choose a primary care provider and then all diagnosis and preventative care are covered without the need for a copay. This includes things like your routine exams, X-rays, and fluoride treatments. Seniors are likely to especially appreciate that there is no waiting period, so coverage begins immediately. You will need a referral should you require the services of a specialist, but there is no deductible necessary, again making dental coverage all the more affordable for seniors on a limited income.

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