Finding the Best Annual Maximum Benefit with Dental Insurance

Dental Health
By: Spirit Dental
July 18, 2023

A young woman finding the best annual maximum benefit with Spirt Dental's guide

Dental insurance can be difficult to understand. With so many costs and elements associated with a plan, it’s hard to know exactly how much you’re paying and whether you’re getting the most value. 

Annual maximums are an important piece of the dental insurance puzzle, in that they can significantly impact how much you’ll pay out of pocket in a given year. We’re here to help simplify the concept of an annual maximum and help you find affordable dental insurance to suit your healthcare needs. 

What does annual maximum mean for dental insurance?

An annual maximum is the maximum amount of money that your dental insurance plan will pay for covered services within a policy year.

Many dental insurance plans offer high annual maximums, especially for preventive services such as routine check-ups, cleanings, and X-rays. By having a plan with a high annual maximum, you can rest assured that the costs associated with preventive care are covered, allowing you to focus on maintaining optimal oral health without worrying about the financial burden.

However, high annual maximums in dental insurance plans go beyond covering preventive care. They also play a crucial role in making other necessary dental treatments — like fillings, extractions, root canals and crowns — more affordable. With a dental insurance plan that offers a high annual maximum, you have access to a greater pool of funds for these major services when you need them, alleviating the financial strain without compromising your oral health.

It’s important to note that high annual maximums aren’t suitable for everyone. For individuals who require minimal or no dental treatments, a plan with a lower annual maximum might be more cost-effective.  

But when you need coverage, having a high annual maximum helps your dental savings stretch further. 

Average dental insurance costs

The cost of dental insurance per month can vary depending on factors such as the type of plan, location, and whether you have individual or family coverage. On average, the monthly cost for dental insurance ranges from $15 to $50 per person. This cost typically includes coverage for preventive services.

One significant advantage of dental plans with high annual maximums is their ability to provide coverage for complex dental treatments. These high-cost treatments may include:

Without insurance, the expenses associated with these treatments can be daunting. However, dental plans with high annual maximums offer individuals the opportunity to receive the necessary dental care they need while keeping their out-of-pocket costs under control. 

What to expect when shopping dental insurance for major dental services

When shopping for dental insurance, it is essential to compare different plans to find the one that best suits your needs. Consider factors like the coverage provided for major dental services, the network of dentists available, and the cost of premiums. By carefully assessing and comparing plans, you can identify the one that offers the most comprehensive coverage for the major dental treatments you may require.

Another important consideration when shopping for insurance is waiting periods. Some dental insurance policies may have waiting periods before coverage for major services kicks in. Waiting periods can range from a few months to a year, depending on the plan. It is crucial to understand and take into account the waiting period to ensure you have the coverage you need — when you need it.

Network savings play a significant role in dental insurance, particularly in relation to your choice of dentist. Preferred Provider Organization (PPO) plans offer the flexibility to choose any dentist, regardless of whether they’re in-network or out-of-network. Health Maintenance Organization (HMO) plans may have limitations on which dentists you can see. Indemnity plans like Spirit Choice offer a fee-for-service model that provides better out-of-network coverage. 

Finally, it’s important to consider other crucial factors like co-pays, deductibles and coinsurance:

  • Co-pays are pre-set amounts you’re required to pay to receive a procedure or treatment covered by your insurance provider.
  • Deductibles are the amount you must pay for dental services out of pocket before ‌ insurance coverage kicks in.
  • Coinsurance refers to the percentage of the dental service cost you are responsible for after meeting the deductible. 

Understanding these out-of-pocket costs is important to gauge the value and affordability of different dental plans.

What to do when your dental coverage is maxed out

Once you reach your annual maximum, you’ll be responsible for any additional services incurred within that 12-month period. There are a few ways you can avoid paying hundreds or thousands for the treatments you need after maxing out your coverage.

1. Supplemental insurance  

Supplementary (or secondary) dental insurance provides additional coverage for patients who have reached the maximum limit of their primary dental insurance. When individuals have exhausted their primary insurance benefits, supplementary dental insurance kicks in to cover eligible dental services, helping to reduce out-of-pocket expenses and ensuring continued access to necessary dental care. 

2. Dental savings plans

A dental savings plan operates as an alternative to traditional dental insurance, offering discounted rates on dental services for patients who have maxed out their primary insurance or do not have dental insurance coverage. When individuals exhaust their primary insurance benefits, they can enroll in a dental savings plan and receive reduced fees for various dental treatments and procedures. This allows patients to access necessary dental care at a more affordable cost, making it a viable option for those who need ongoing or extensive dental services, even after reaching the maximum limit of their primary insurance coverage. 

3. Plans with higher annual maximums 

​​Enrolling in a dental insurance plan with a higher annual maximum can be a strategic move to avoid paying thousands of dollars for dental services. By opting for a plan with a higher annual maximum, individuals can access a larger pool of funds to cover their dental expenses throughout the policy year. This means that when major dental services are needed, such as complex procedures or treatments, ‌insurance coverage will extend further, significantly reducing out-of-pocket costs.

Find the best dental insurance plan with a high annual maximum with Spirit

Spirit Dental offers flexible plans that suit everyone’s needs. Whether you need coverage now or require extensive work, we’ve got policies with no waiting periods and high annual maximums so you don’t have to sacrifice your health for the sake of saving money.

Don’t put it off any longer, discover the best plan for you today.

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