capline dental services

What is a Dental Insurance Deductible

What is a Closed Network Plan
December 18, 2020
What is Balance Billing?
December 22, 2020

You are likely to consider cost comparison and different premium options while taking dental insurance. The one thing you may not be aware of is the dental insurance deductible, the minimum amount paid to a dentist to get insurance benefits. You need not worry as deductibles are probably one of the simplest and direct aspects of dental insurance.  

Dental Insurance Deductibles – Individual and Family 

Talking about the individual deductible, it’s the ‘minimum’ amount you need to pay out-of-pocket to your dentist before you start getting your dental insurance benefits. In simple words, whatever amount you directly pay to your dentist before your insurance plan starts paying for the dental services you receive is called a dental insurance deductible

A family dental insurance plan typically has an individual deductible as well as a family deductible. However, an individual deductible can be used per person until it reaches the limit of the family deductible.

Let’s assume that as per your family insurance plan, your family deductible is $100 and the individual deductible is $50. If two family members use their individual deductible, the limit of the family deductible is reached. So, other family members covered in the insurance plan who need dental treatment would not have any deductible for that calendar year. 

You are most likely to have a deductible if you have taken dental insurance. However, it’s advisable to check whether the amount you need to pay as deductible fits your pocket or not. 

Note: If your insurance plan has a deductible, paying it will allow you to avail the benefits of your insurance plan.

How Dental Insurance Deductible works?

Generally, a deductible is a specific amount and works the same way for all types of insurance. If, as per your insurance, the amount for the deductible is $100, you need to pay it to make an insurance claim. 

A generally asked question is that do all dental services have a deductible? It entirely depends on your dental insurance plan. Some dental plans have deductibles for all dental treatments and procedures, while some plans do not have deductibles for preventive care like cleanings, fluoride treatment, and diagnostic services. So, if you do not require any of these dental services for one year, you would not need to pay anything toward your deductible. You can check with your dental insurance provider as well to know about deductibles. 

How are dentists affected by deductible?

People are generally hesitant to pay any out-of-pocket cost, especially when they have taken dental insurance to take care of any required dental treatment. That’s the reason a lot of people try searching for an insurance plan that has no or minimum deductible without thinking that it’s vital to get all the benefits of their insurance plan. It directly affects the dental practitioners in terms of revenue and the number of patients. 

How to guide patients to collect deductibles?

Dentists need to guide their patients about the importance of paying deductibles. They can make the patients aware of the following points:

  • Paying deductibles gives you the freedom to visit almost any dentist to get the required treatment and still get partial or full coverage as per the policy of your insurance plan.
  • It’s the ‘MINIMUM’ cost that you need to pay to get the benefits of your dental insurance plan.
  • If you choose the insurance plan with no or minimum deductibles, you are restricted to only in-network dentists if you want to get full insurance coverage. 
  • It’s also possible that you may or may not have an in-network dentist near you in case of any urgent treatment if you have taken an insurance plan with no deductibles. 

How insurance verification can help to maximize deductible collection?

A proper insurance verification verifies a lot of things before approving a patient’s claim. Beyond verifying patient information & policy status, copays, coinsurances, and coverage, it also verifies deductibles. 

Dentists are required to ask their in-house insurance team to perform a thorough insurance verification for all the patients to maximize deductible collection. If you have outsourced dental insurance services for your patients to a reliable dental services partner such as CAPLINE, you can stay assured of all the necessary steps required for insurance verification. 


There are some general questions asked by patients as far as deductibles are concerned. Here are some popular ones:

1. Does a personal dental preventive plan have a deductible?

Ans. No. Deductibles are not applied to any preventive dental treatment. There are no deductibles for the Personal Dental Preventive Plan.

2. Should I get an individual dental plan or a family dental plan? 

Ans. It entirely depends on your requirements. If you are a single parent with a child on Medicaid or CHIP plan, an individual dental plan will probably suit your pocket and requirements. A family dental plan should be your first choice if more than one member of your family is not on a Medicaid or CHIP plan.

3. Can I go to any dentist for treatment?

Ans. Yes, you can! However, if you go to an out-of-network dentist, your out-of-pocket cost will increase as you may not get discounts or complete coverage which you get with an in-network dentist.