What To Do If Your Dental Insurance Coverage is Maxed Out

Your dentist just told you that you need a root canal and a crown. No problem, you’ve got dental insurance. But you may still end up paying out-of-pocket for the procedure if you exceed your insurance’s annual “cap,” also known as the annual maximum spending limit. In this article, we’ll cover what to do, and ways to continue saving on dental care after maxing out your coverage.

What is an annual maximum for dental insurance?

Dental insurance, including plans offered by many Medicare Advantage programs, typically has a yearly cap of $1000 to $1500 per individual covered by the plan. Once this annual maximum is met, you’ll be responsible for paying for any further dental treatments until the start of the next plan year.

As you might have experienced, a single restorative procedure such as a root canal and crown can easily deplete your insurance coverage. Crowns typically cost between $750 and $2000 per tooth on average, while root canals range from $750 to over $1000 per tooth. These expenses quickly eat into the annual dental benefits ranging from $1000 to $1500.

Is there a maximum I’ll pay out of pocket with dental insurance?

Unlike medical insurance, which typically has an out-of-pocket maximum – a point at which you stop paying for care – dental insurance does not usually have a maximum out-of-pocket (plan details vary, so always check your coverage details). This means you’ll be responsible for the full out-of-pocket costs.

There is one exception: if you have a stand-alone dental insurance plan, certified by the Affordable Care Act (ACA/Obamacare) exchange, there is a limit. In 2023 the maximum out-of-pocket cost is $375 for one child, and $750 for a family with more than one child covered by the plan. In 2024, that amount is set to increase to $400 per child, and $800 for multiple children covered on a family policy.

How to save after you maxed out your dental insurance

Once you’ve reached your annual limit, you’re responsible for the full cost of any dental care you need. You can ask your dentist about a payment plan for the amount you’re responsible for, or you may want to consider supplemental dental insurance coverage or a dental savings plan – both can help fill the financial gaps when your traditional dental insurance has hit its limit.

Scenarios for Reaching Annual Maximums

Dental insurance plans typically come with an annual maximum or a maximum benefit limit, meaning that once you reach a set dollar amount, you are responsible for any additional costs during the benefit period. There are a variety of scenarios where you might hit your annual maximum benefit:

1. Major Dental Treatments: Procedures like dental implants and orthodontic services can quickly deplete your dental benefits, as they tend to be expensive. For instance, dental implants can cost thousands of dollars, which may surpass your plan’s maximum dollar amount.
2. Multiple Procedures in One Year: If you require several dental procedures in a short period, such as root canals, crowns, and fillings, the costs can accumulate rapidly. These dental treatments can lead to hitting your annual maximum early, especially with dental insurance policies that only cover basic services.
3. High-Cost Services: Dental procedures like dental work involving crowns, bridges, or dentures often carry significant costs, pushing you towards your maximum benefit faster. For instance, a single dental procedure like a crown can exceed $1,000, which could quickly eat up your plan’s benefits.
4. Out-of-Network Services: If you opt for dental providers outside of your dental PPO network or dental HMO, your coverage might not apply in full, requiring you to pay more out of pocket. Using a participating dentist within your plan’s network can help maximize your dental insurance coverage.
5. Orthodontic Care for Children: If you’re seeking orthodontic services for your child, this could be another area where the annual maximum gets exhausted. Some dental insurance policies offer orthodontic coverage, but it often comes with strict limits.

Always review the details of your dental plan and ask for a pre-treatment estimate from your participating dentist to understand how your insurance will apply to the cost of each dental procedure.

Supplemental Dental Insurance Coverage

You can get a Supplemental dental insurance coverage plan – a type of plan that is typically purchased for a specific costly treatment, such as braces, dental implants or veneers – for a year or two. If you’re considering this type of plan, make sure the dental insurance plan has no waiting period before your procedure is covered.
. With a new-to-you plan, you may have to wait six months for basic restorative services or a year for major restorative services.

The good news is that supplemental dental insurance policies tend to have no annual spending limits and no deductibles. The bad news is that supplemental dental insurance policies also tend to be expensive, assume you’ll pay at least as much for your supplemental plan as you do for your primary plan.

Advantages of dental savings plans

Dental savings plans are a trusted alternative to dental insurance that can save plan members an average of 50%* on their dental care. They can be used alongside a dental insurance plan to step in, when your insurance is maxed out. Speak to your dentist to coordinate your plans.

Dental savings plans provide savings on virtually all treatments – from braces to dentures. And while traditional dental insurance often has annual spending caps, waiting periods, approval process or restrictions on pre-existing conditions, dental savings plans do not.

Dental savings plans are very affordable. The plans on DentalPlans.com start at just $79.95 annually for an individual. Plus, many dental savings plans include additional wellness benefits, such as savings on vision and hearing care, prescriptions, and more, at no extra cost.

To learn more about dental savings plans, call our expert team at 1-833-735-0399 – we’ll answer any questions and provide you with a plan recommendation in minutes. Want to take a quick look at what a dental savings plan can save you right now? Use our calculator below.

*Discount Health Program consumer and provider surveys indicate average savings of 50%. Savings may vary by provider, location, and plan.