Dental Plans: Co-payment

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Patient resource: Understanding the Dental Plan Co-payment

What is the dental plan co-payment?

The co-payment is the patient's portion of the cost of care. Dental plans are an employee benefit designed to offset the cost of dental care. Generally a dental plan will only cover a portion of the cost of any treatment service—the patient is responsible for any costs not covered by the plan (the co-payment).

Your dentist has a legal and regulatory requirement to collect the co-payment from all patients.

How much do I have to pay?

This will depend on your plan coverage. Many plans will cover a percentage of costs for eligible services. For example a plan may cover 80 percent of the cost of basic/preventive services such as examinations, fillings, and cleanings. This percentage is based on the costs outlined by the plan provider and may vary from the actual costs of the treatment. Major procedures such as crowns, bridges, and dentures may be covered at 50 percent of the cost outlined by the plan. You are responsible for any costs not covered by the plan.

Review your dental plan to understand your coverage. See also: How can I find out what my dental plan covers?

Why do I have to pay the co-payment?

You dental plan is an agreement between you and your dental plan company that they will cover a percentage of the eligible treatment based on the details outlined in your plan. Both you and your dentist sign a claim to agree to the total cost of treatment. If you are not paying your share of the agreement you are making a false declaration, as is the dentist.

A dentist must accurately reflect the percentage of the total cost that is being charged to the insurance company and collect the remaining costs from the patient.