Like health insurance, dental insurance works by sharing the costs of dental care in exchange for a premium you pay. You may also have to pay deductibles, copays and other costs, but the details vary from plan to plan. Here are some common terms of dental insurance plans:
Premiums
A premium is what you pay your insurer in exchange for coverage. Premiums are typically billed monthly, but some policies may collect them semiannually or annually. A typical premium may be $20–$50/month for an individual or $50–$150/month for a family based on the type of coverage.1
Deductible
A deductible is the amount you pay toward certain dental expenses before your insurance kicks in. For example: if you have a $1,000 deductible, you pay the first $1,000 of covered services and then a fixed amount (ex. $20) for covered services after the deductible is met. Deductibles typically reset after 12 months.
Coinsurance
Coinsurance is a payment you may be responsible for after you meet your deductible. For example: if your dental plan pays 70% of the cost, your coinsurance payment is the remaining 30% of the cost.
Annual coverage maximum
An annual maximum is the limit your dental insurance will pay toward the cost of dental treatment in a plan year. For example: if your annual maximum is $2,000 and your plan has already paid $2,000 in the first 6 months, you’re responsible for 100% of the costs for the remaining 6 months.
In-network vs out-of-network
A network is a group of dentists who have agreed to provide care based on a plan’s terms and conditions. If you choose an in-network dentist, you’ll typically pay less for treatment. If you choose an out-of-network dentists, you could pay higher deductibles, copays and coinsurance.
Reimbursement
An insurance reimbursement is the money your insurer pays to a dentist to cover the expenses of the services provided. Typically, the payment occurs after you receive a medical service, which is why it is called reimbursement.