What are dental insurance maximums?

Maximums – Almost all dental insurances have annual caps to how much they will pay out.   Many fall into the $1000-2000 range but some go up to $5000. A plan with a higher maximum will likely cost you more on an annual basis but will go further for you if you have a lot of dental care needs.  There are also lifetime maximums for specific services like orthodontic care if you need braces or Invisalign.

Why should you care about dental insurance maximums?  These are the effective the limits of your dental insurance benefits.  If your plan only has a limited $750 annual maximum, this will only cover a couple of cleanings, some x-rays, and maybe a filling.  But if it has a higher annual maximum, then it will contribute more to your care before you have to start paying for everything yourself.

If I already reached my annual maximum is my dental insurance still helping?  This depends on if your dentist is in-network or out-of-network.  If you are seeing an in-network dentist then your care is inherently more affordable because the fees you pay for your dental care will be substantially lower.  Fees negotiated by your insurance company can be anywhere between 25-60% lower than typical office fees.  So having dental insurance can save you 25-60% just by seeing an in-network dentist!  On the other hand, if you see an out-of-network dentist you will end up hitting your maximum sooner since the fees will not be discounted.  Also, once you hit the annual maximum you will be paying full cost for every procedure with no discount.

Does seeing an in-network dentist affect my annual maximum?  Yes and no.  The annual maximum is set, depending on your plan, regardless of which dentist you see.  However, if you are seeing an out-of-network dentist their fees are likely much higher, and you will reach your annual maximum much faster.  Staying in-network helps you stretch your benefits and this does not always mean you have sacrificed quality.  Dr. Corpron provides the same high quality level of care for all of his patients at Blue Sky Family Dentistry.

What is a lifetime maximum?  These are very specific maximums that are calculated separately from your annual maximum.  So say you came to our office and you got a cleaning, some x-rays, and an exam.  These preventive services will come out of your annual maximum.  But then let’s pretend you needed to correct your bite, and you needed orthodontic treatment like Invisalign.  If you decided to take your doctor’s advice and realign your teeth with Invisalign then this will come out of a separately calculated lifetime maximum.  This does not affect your annual maximum.  The annual and lifetime maximums are separate.


I hope this helps and stay tuned for more information as we continue to demystify your dental insurance benefits.


Dr. Corpron is a family dentist who started Blue Sky Family Dentistry so that he and his staff could be a resource to everyone in the Austin area.  Located in Circle C, the dental office is minutes away from Meridian, Avana, Oak Hill, Bear Creek, and other South Austin communities.  The office is in-network with Aetna, Ameritas, Cigna, Careington, Delta Dental, the Dental Network of America (DNOA), Guardian, Humana, Principle, Metlife, Sunlife Financial, Sunlife or Assurant or the Dental Health Alliance, United Healthcare, and more.  Call today so we can verify your dental benefits on your behalf.  We want to make sure you fully understand your dental insurance so you can get the most benefit from it.  Schedule the whole family today!