Visiting the dentist is an essential part of maintaining oral health, but sometimes unexpected expenses can arise even after your dental appointment. Understanding why these out-of-pocket costs occur can help you better prepare for future visits and manage your budget more effectively.
Reasons for out-of-pocket expenses after a dental appointment
Here are five common causes of out-of-pocket expenses after a dental appointment:
Your dental plan has a deductible
Some dental plans may have deductibles that you must meet before your coverage kicks in. If you haven’t met your deductible for the year, you may be responsible for covering the full out-of-pocket cost of certain dental services until the deductible is met.
Preventive care services like cleanings are covered at 100 percent right off the bat, even if your deductible hasn’t been met yet.
Sign into your member portal or check your member ID card to see what your plan’s deductible is.
Your dental plan doesn’t fully cover the dental work you need
After your deductible is met, Delta Dental of New Mexico will pay for a percentage of treatment costs. You, the member, may also be required to pay the remaining balance after we pay our portion. This is known as coinsurance. Paying coinsurance will not start until you’ve met the required deductible, so you won’t be paying both at the same time.
To explain further, let’s say your dentist comes across signs of a cavity during an appointment. Typically, the necessary filling is covered at 80 percent. That means Delta Dental of New Mexico will pay the majority of the cost, leaving you with a 20 percent out-of-pocket cost to pay. The 80/20 split between you and Delta Dental of New Mexico is your coinsurance.
Your treatment requires a copayment
When you choose your dental plan, you should note if there are copayments. These are fees required for dental services. All copays are a fixed dollar amount that won’t change depending on the cost of the dental work you’re getting.
You hit your annual maximum and still have treatment scheduled in that plan year
Many dental plans have an annual maximum. This is the total dollar amount that Delta Dental of New Mexico will pay toward treatment during one plan year. For example, say your plan states that your annual maximum is $1,000, and in one plan year you had three restorative dental procedures that totaled $1,300. Because you exceeded your annual maximum by $300, you are responsible for paying that $300.
Once the plan year resets, your annual maximum does, too. (Click here to sign into our member portal to review your plan details.)
Your treatment isn’t covered by your plan
Dental coverage depends on your plan’s specific design, and not all plans cover all treatments!
If you want to have veneers put on your teeth or a special whitening treatment done, these would most likely be considered cosmetic services and have out-of-pocket costs. Cosmetic dental procedures focus on improving the appearance of a person’s mouth rather than providing preventive care. Cosmetic services often aren’t covered by dental benefits plans, so you’d have to pay the total cost.
Delta Dental of New Mexico believes in preventive care
Delta Dental of New Mexico dental plans often cover 100 percent of routine preventive and diagnostic care. This includes procedures like cleanings, exams, and X-rays.
Why do we cover these procedures? We believe in the power of preventive care. When you maintain your preventive care appointments, you reduce your chances of needing expensive, restorative dental procedures in the future. This helps keep out-of-pocket costs to a minimum.
Click here to learn more about preventive care.
*Updated June 2024