Copayment and coinsurance are two terms you may come across when reviewing your dental insurance. Both can be described as ways you help share the costs of your dental care. Usually there is a copay or coinsurance, but not both. Here’s an explanation of the two terms with some additional information:
Copayment, also referred to as a copay, is a fixed dollar amount you’re required to pay for a service or treatment.
When there is a copay, there may not be a deductible or an annual maximum. A deductible is the dollar amount you have to pay before your dental plan begins to pay the cost of covered dental services. This amount will vary by plan. Your annual maximum is the most money a plan will pay toward your dental care within a benefit period, usually a calendar year.
Coinsurance is the amount, represented as a fixed percentage, you will have to pay toward a dental treatment. Your insurance plan pays the other percent. For example, you may be responsible for 20 percent of a service you received at the dentist, and then Advantica covers the other 80 percent of the cost. In terms of dollars, for example, if your total bill is $100 for a certain service, you’ll pay $20 and Advantica will pay $80. Keep in mind, you will first need to meet your plan’s deductible and you may have an annual maximum.