I went to the dentist today and I need to get a mouth guard. My insurance covers the cost 80% plus deductible.
I’ve never had to use my insurance for more than preventative care so I don’t quite understand deductibles.
Basically since I haven’t paid any deductibles will I have to pay full price for the mouth guard? Or is it a set amount I pay.
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Say you have a $500 deductible. You will pay the first $500, then 20% of the remaining balance. If your procedure is $2000, you pay $500, then 20% of the $1500 remaining, so another $300, for a total of $800 out of pocket.
Your deductible is the amount of money you have to pay for medical care yourself before your insurance will start covering a certain percentage of all future medical bills. You only have to pay the deductible amount once per year.
Once your deductible is met, your insurance will start covering a percentage of bills for care you receive*, in your case, 80%. You will pay the remaining amount (20%) out of pocket. *(Bills have to be for an approved service with an in-network provider)
So let’s say your deductible is $100 and your dentist charges $100 per visit. You see the dentist in January, and you have to pay the entire bill yourself, in this case, $100. You see the dentist again in 6 months, and the bill is $100 again. Since you already paid the deductible amount ($100) at your last visit, your insurance company will now pay 80% of the bill. In this case, your insurance company will pay $80 and you must pay the remaining $20 per visit. At the end of every year, your deductible resets and you have to pay that deductible amount again before the insurance company will start paying.
You have to pay the deductible, then the insurance covers 80% of the rest. For dental insurance, you probably have to pay the deductible only once per year for non-preventive services.
So if you have a $50 deductible, and the procedure is $550, you pay $50 plus 20% of $500, for a total of $150.
Also, this is assuming your dentist is in-network with your insurance. If they aren’t, you’ll almost definitely be paying extra. Insurance pays 80% up to a certain contracted amount, and the rest is either up to the dentist to waive (if they are in network) or you have to pay it (if they aren’t).
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