Premium
Defining premium, deductible, copay, and coinsurance
Oral and vision health benefits can feel confusing, but knowing a few key terms can help you plan for costs and make the most of your coverage. With that in mind, let’s define four important words — premium, deductible, copay, and coinsurance — so you can understand how each influences what you pay for checkups, cleanings, and more.
Your premium is the regular payment that keeps your dental and vision plans active. It is often monthly but can also be quarterly or annual. If your employer covers part of the cost, you’ll pay the remainder. Knowing your premium helps you budget for coverage even before you visit the dentist.
Deductible
A deductible is the amount you must pay for covered services before your dental plan starts to pay. For example, if your deductible is $50, you pay the first $50 of treatment, then your plan will pay its portion.
Copay
A copay is a fixed amount you pay for a specific dental service. For example, your plan might require a $20 copay for a routine cleaning or $50 for a filling. You pay this amount at the time of service, and it won’t change based on the total cost of the treatment — so you’ll know exactly what to pay before you begin! Copays do not typically count toward your deductible or your out-of-pocket maximum.
Coinsurance
Coinsurance is similar to a copay, but it is always expressed as a percentage of the total charge. For example, if your plan covers 80% of a treatment, your coinsurance, the amount you pay, is 20%. Coinsurance applies after you meet your deductible.
The more you know
Understanding these four terms is a great start that empowers you to compare plans, estimate expenses, and choose the coverage that best fits your budget. Review the specifics of your plan so you know your deductible, any copays or coinsurance, and how much they cover.
