What's the Difference Between Copay and Coinsurance?

Posted on March 6, 2018 in Dental benefit information

Copayment and coinsurance1 are both ways you help share the costs of dental care with Delta Dental of Illinois. Most of the time, Delta Dental of Illinois members have a copay or coinsurance, but not both.

Here's what you need to know:

Copayment, also known as a copay, is a set dollar amount you are required to pay your dentist for a service.

When you have a copayment, you may not have to worry about a deductible or an annual maximum.  A deductible is the set dollar amount you have to pay before your dental plan kicks in for covered services. Deductible amounts vary from plan to plan. An annual maximum is the most a dental plan will pay toward your dental care within a specific period, typically a calendar year.

Under most plans, you do not have to pay your deductible to receive preventive care such as exams, X-rays and cleanings – your benefits plan will likely cover those at 100 percent at no cost to you. So make sure to schedule regular preventive checkups!

Coinsurance is a fixed percentage of a treatment cost you share with your dental plan. For example, you may be responsible for 20 percent of a given service while Delta Dental of Illinois covers the other 80 percent. Meaning that if your total bill is $100 for a given service, you'll pay $20 and Delta Dental will pay $80. However, you must first meet your deductible and you may have an annual maximum for the year.

To learn more about your dental plan's copay or coinsurance, login at deltadentalil.com. You can also call the customer service number on your Delta Dental of Illinois ID card.

1 https://www.nerdwallet.com/blog/health/copay-vs-coinsurance/