Most dental plans have an annual plan maximum. This doesn’t refer to the most you will pay out of pocket. Instead, this is the maximum dollar amount a dental benefit plan will pay toward the cost of dental care within a specific benefit period (typically January through December).
The patient is personally responsible for paying costs above the annual plan maximum. Consult your benefits booklet for specific information about your plan’s annual plan maximum.
To further clarify what an annual plan maximum actually is, here’s a quick example:
Let’s say you have a plan with an annual plan maximum of $1,000. Your dentist says you need a crown that will cost $800. According to your plan benefits your share of the cost is 50%, so you’ll pay $400 and your plan will pay the other $400. Because your plan has paid $400 toward your dental expenses so far for the year, subtracting that from the $1,000 plan maximum means the plan will contribute $600 toward any future eligible dental costs for the remaining part of that 12-month period.
Do you have a better understanding of annual plan maximums now? What other dental definitions would you like us to decode?