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The Difference Between Coinsurance, Deductibles and Copay

Posted on October 24, 2019 in Dental benefit information


7001 Facebook-960x9602Deductibles, copay and coinsurance are all ways you share the costs of dental care with your benefits company – but they all operate a little differently. It's important to understand these insurance terms in order to make the most of your dental coverage.

A deductible is the total amount you pay before your dental benefits carrier helps with the costs. Let's say you have a $100 deductible and you need to get a crown that costs $618. You will need to pay your share – $100 – before your benefits carrier pays its portion of the remaining $518. You only have to pay your deductible once every plan year, so after you have, your coverage will kick in immediately if you need another dental service a few months down the road.

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 percentage of the cost you pay for a dental procedure. Here's an example using an in-network dentist: 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 your deductible is reached.1

Copay is a fixed dollar amount you pay for a covered service.2 Typically, only Dental HMO-style plans require a copay, so be sure to review your plan details. This 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.

1 https://www.deltadental.com/Public/FAQ/patientFAQ.jsp
2 https://www.healthcare.gov/glossary/co-payment/