Dental Benefits Explained | What is an Annual Maximum
Dental benefits work better when you know how to put them to use. The first step in achieving this is understanding what dental benefits do and how they work. Gain insight into what an annual maximum on a dental plan is to make the most of your dental coverage.
Annual Maximums on Dental Plans
Dental plans will differ depending on what you signed up for. Most dental plans have what is called an “annual maximum" or "annual benefit maximum.” This is the total amount of money the dental benefits provider—say Delta Dental—will pay for a member’s dental care within a 12-month period. That time period is called a benefit period.
A benefit period can start at different points of the year. For now, we’ll assume your plan’s benefit period is the calendar year. That would mean the annual maximum for your plan’s year applies to January through December.
If your plan’s annual maximum is $1,500, your dental benefits provider will pay for their portion of your dental work based on your plan's coverage/coinsurance amounts, until they pay out a total of $1,500. Your plan’s details will explain if a procedure has cost sharing. The annual maximum on your dental plan resets at the beginning of each benefit period.
Keep in mind that depending on your dental plan, services that are considered diagnostic or preventive may not count toward your annual maximum.
The annual maximum in a dental plan is often confused with the term “out-of-pocket maximum.” The annual maximum refers to the maximum amount the dental benefits provider like Delta Dental will pay out in one plan year. Conversely, the “out-of-pocket maximum” refers to the maximum amount you, the member, will pay in one plan year.
Here is an example of how a Dental Plan's Annual Maximum works*:
- Your plan has an annual maximum of $1,500.
- Your dentist says you need a cavity filling in January. The cost for that procedure is $100, you plan covers fillings at 80%, so your dental plan pays $80. (That's $80 subtracted from your annual maximum for the year: $1,420 remaining)
- Then, in March you need to get a root canal, which is $700. Your plan covers root canals at 80%, meaning your dental plan pays $560. (Your dental plan has now paid $640 towards your dental care in this benefit period out of your $1,500 annual maximum: $860 remaining)
- In October, you need a crown, the cost of which is $900. Your dental plan covers crowns at 50%, meaning your dental plan would pay $450. (In this example, you’ve now used $1,090 of your $1500 annual maximum: $410 remaining that can still be used during your benefit period)
- If you reach your annual maximum for your benefit period, meaning Delta Dental has paid $1,500 towards your dental services, any services after that are 100% your responsibility until the next benefit period.
- At the end of your benefit period, your annual maximum resets back to $1,500.
*example is for illustrative purposes only. Please see your benefit booklet for your plan's specific coverage information.
How do I find my plan specifics?
Log in to your member account to find your benefit information on:
- Your benefit period
- Your plan's annual maximum
- What percentage Delta Dental covers for Diagnostic & Preventive, Basic and Major Services.