Dental Insurance Maximizer Calculator

Insurance Pays is capped at whatever Remaining Benefit is left in your Annual Maximum Benefit for the year, regardless of how large the procedure cost or the coinsurance-calculated payment would otherwise be. Once a large enough procedure cost pushes the calculated insurance payment up to that remaining cap, any additional cost above that point falls entirely to Your Out-of-Pocket Cost.

It can, for the exact same procedure, if Benefits Already Used has grown between the two dates. A higher Benefits Already Used value shrinks Remaining Benefit, which lowers the cap on Insurance Pays -- so the identical Pending Procedure Cost entered later in the year, after more of the annual maximum has already been used, can result in more coming out of your own pocket than the same procedure scheduled earlier.

Coinsurance Rate sets the percentage of the deductible-adjusted procedure cost the plan covers -- for example, an 80% coinsurance rate means the plan pays 80 cents of every dollar of covered cost above the deductible, leaving you the remaining 20 cents, up to the Remaining Benefit cap. A higher Coinsurance Rate always increases Insurance Pays for the same procedure cost, before that cap is reached.

Before. This calculator first determines how much of the Annual Deductible is still unmet (using Benefits Already Used), subtracts that unmet amount from Pending Procedure Cost, and only then applies Coinsurance Rate to what's left -- matching how most dental plans structure coverage, where deductible dollars are paid entirely out of pocket before coinsurance-based cost-sharing begins.