What will my dental plan actually pay?

Table 1 — Where to find each number

What to look up

Why the real number can differ

Three things this arithmetic cannot know

Plans pay a percentage of their own allowed amount for a procedure, which can be lower than what your dentist charges. With an in-network dentist the difference is usually written off; out of network, you may owe it.

Waiting periods can mean a new plan pays nothing for major work in its first months. And exclusions, such as a missing-tooth clause or a limit on how often a crown can be replaced, can remove coverage for a specific procedure altogether.

The way to find out for certain is a pre-treatment estimate: the dental office sends the plan to your insurer, and the insurer writes back with what it will pay.

Common questions

How do I calculate what my dental insurance will pay?

Take the fee, subtract any deductible you still owe, and multiply the rest by your plan's coverage percentage for that kind of procedure. If that is more than what remains of your annual maximum, the plan pays only what remains. You pay the rest.

What is an annual maximum?

It is the most your dental plan will pay in a plan year. Once the plan has paid that much, you pay everything else until the year resets. A single crown or root canal can use up a large share of it.

What does 100-80-50 mean?

It is a common way dental plans are structured: preventive care covered in full, basic procedures such as fillings at a higher share, and major procedures such as crowns at a lower share. Your own plan's percentages and categories may differ, so use the numbers on your plan summary.