Dr. Tranfaglia is a Somerville Dentist

The Basics on How Dental Insurance Works



Deductible​

​​A deductible is a specified amount which must be paid by the patient before the insurance starts to pay. For example, if you have a $50.00 deductible you need to pay that on the first visit for any procedure that requires a deductible, this usually has to be met once each year.  Most cleanings and check ups are covered 100% with no deductible and no co-pay, for two visits a year.  Most deductibles start on any procedure beyond that.​​



PATIENT PORTION / C0-Pay​​​

​​The second thing to consider is your portion to pay on procedures that are not covered 100 %. After the deductible is met, your insurance may cover only a portion of  the procedure, and then the patient is responsible to pay the remaining portion of the bill. The patient portion we are calling the co-pay. For example, many plans cover 80% of a filling after your deductible is paid, the remaining 20% is your co-pay/patient portion.



Yearly Maximum

​Most dental insurance plans have a maximum amount of money they will pay each year toward  your dental needs. The typical range on maximums range from $750.00 to $2,000. When a plan has paid the maximum payment amount for that year, you are responsible for 100% of any new dental charges. Most insurance maximums start again every January 1st of each year.​​ Some start again on july 1st.



Waiting Period​​​

Some insurance plans have a waiting period for certain procedures, they can vary anywhere from 3 months to 2 years.​​

Bottom Line​​​

You need to understand your own insurance because policies vary from company to company and employee to employee.​