Overview
A dental annual maximum (also known as a plan year maximum) is the maximum your dental plan will pay for your dental care in one plan year.
Annual maximums typically range between $1,000 and $2,000 – and most people never reach this amount in their benefit period. According to a study conducted by the American Dental Association Health Policy Institute in 2024, only 3.4% of dental patients reach their dental annual maximum each year.
To make the most out of your dental coverage, it’s important to understand what goes into your annual maximum as well as what your dental benefits do and how they work.
How Dental Annual Maximums Work
At the start of each benefit period — usually at the beginning of the year — the maximum is set to pay for your dental care. Every time a dental claim is submitted, the cost that your insurance carrier paid on your behalf is subtracted from your maximum. Once you reach the maximum, your dental benefits stop, and your plan won’t pay for additional care. At this point, you’re 100% responsible for any additional dental services until the next dental benefit period begins.
Some key things to remember when considering your dental annual maximum:
- Your deductible doesn’t apply to the annual maximum.
- Any copays on your plan don’t apply to the annual maximum.
- Costs that accumulate after your deductible and copay are satisfied do apply toward your annual maximum
- Some coinsurance percentages covered by your dental carrier are applied to your annual maximum.
In the end, if you are concerned about your dental annual maximum, it’s always a good idea to talk to your dentist about costs when scheduling dental treatments. Be upfront about wanting to stay within your dental annual maximum.
By working in partnership with your dentist, you may be able to set up a treatment plan that spreads out out-of-pocket costs while still meeting your dental needs.
Quick Answers
Does my annual maximum start at the beginning of the calendar year or when I start my plan?
Your annual maximum goes into effect when you start your plan and ends the same day the next year.
I’m already enrolled in a Delta Dental of Washington dental plan. How can I view my plan’s annual maximum and see how much I have left?
If you have an Individual and Family Plan or Washington Health Benefit Exchange Plan, log into your Delta Dental Covers Me online account to view your annual maximum.
If you have an employer-sponsored plan, log into your MySmile® online account to view your annual maximum.
Which Delta Dental of Washington plan has a high annual maximum?
If you’re shopping for a Delta Dental of Washington Individual and Family Plan, the Delta Dental - Premium Plan has a $2000 annual maximum. Both the Delta Dental – Ascent Plan and Delta Dental – Optimum Plan also offer increasing annual maximums that reward you with a higher annual maximum when you renew the plan for up to two years. If you have an employer-sponsored plan, your employer has already selected a plan with a preset annual maximum.
What is Maximum Wellness® and how does it relate to my annual maximum?
Maximum Wellness® is an employer-sponsored group dental plan that rewards members for getting preventive care. Each year you receive a qualifying preventive service, such as a routine checkup, your annual maximum can increase for the following plan year, up to your plan's limit. Because this article is about annual maximums, it's worth knowing that Maximum Wellness offers a different approach by helping eligible members earn a higher annual maximum over time through regular preventive care.
