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What is an annual maximum for dental insurance, and how do they work?

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An annual maximum for a dental insurance plan is the amount of money that an insurance carrier will pay towards each insured individuals dental coverage. This means that if you go into your dentists office for your free cleaning, the dental insurance company is paying for that cleaning and it eats away at that maximum annual benefit. Additionally, if you are in need of a lot of dental work, or very expensive dental work, you would probably be best served to consider buying a plan with a high annual maximum to maximize your dental coverage.  The other thing you need to consider is the percentage of coverage that that particular plan offers for the service you are getting done, and if the plan has any waiting periods for dental services. Meaning if the dental insurance company is paying 50% of your root canal and the root canal is $700, you will each pay $350 of it.

Once the maximum annual benefit has been reached, you are responsible for 100% of the costs until your maximum annual benefit resets. You will want to check with your dental insurance carrier to see when your maximum annual benefit resets. Some reset on your one year anniversary of having the plan, others will reset at the beginning of a new calendar year, on January 1st.

Let's look at an example of how this maximum annual benefit could work:

You have a dental insurance plan that has a maximum annual benefit of $1,500 per year. If you go into your dental office to get your free cleaning, the dental office charged your insurance $120 for that cleaning. Your annual maximum would then go down by that $120, meaning you have $1,380 of benefits remaining for that year.  If you were to then get a root canal and a crown for $1,300, covered at 50% by the insurance, you and your insurance company would each pay $650. Your annual maximum benefit would then be reduced down by the $650, leaving $730 of your annual maximum benefit remaining.

 




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