The Difference Between Annual Maximum and Deductible

Posted on February 16, 2017 in Dental benefit information

Annual maximums and deductibles are common in many health plans, including dental plans.

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 plan's 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. Beyond your annual maximum amount, it's your responsibility to pay for any additional costs until your plan year starts over. If your plan covers orthodontics, there is typically a separate maximum amount that your dental benefits carrier will pay toward the cost of care for orthodontia. Check your plan for specific coverage limits.

A deductible is the total amount you have to pay before your dental benefits plan covers expenses. Let's say you have a $100 deductible and need to get a crown. In this example, let's assume you haven't paid anything towards your deductible so far this year, and a crown costs about $600. You'll need to pay the first $100 of that cost out of your own pocket. After you've paid your $100 deductible, your dental benefits carrier will pay its share of the rest of the bill based on your coverage. The deductible only has to be met once every year – not for each service.

Often, your deductible doesn't apply to preventive services such as regular exams, X-rays and cleanings. Even if you haven't met your deductible, these services may be covered at 100 percent — so make sure to take full advantage of your dental benefits and schedule regular dental checkups!