What are family deductibles?

What is a deductible? 

A deductible refers to the dollar amount you have to pay out-of-pocket for covered dental services before your dental plan starts to pay. 

  • Not all plans include deductibles. If your plan includes one, you are responsible for all your dental costs until you reach your deductible. 
  • Deductibles usually reset every 12 months, typically at the beginning of the calendar year. Check with your dental plan provider to confirm the exact dates.
  • Once you reach the deductible amount, your insurance plan begins paying your oral health care costs minus any coinsurance or co-pays, which are your responsibility.
  • Out-of-network care might not count toward your deductible.
  • As a way to encourage good oral health, most dental plans do not require you to pay a deductible for preventive services such as cleanings and exams. This means the insurer will pay the full percentage of the plan's allowance for preventive care even if you have not met your deductible. Check your coverage details to see if both in-network and out-of-network dentists are included.

What are family deductibles and how do they work? 

In a family dental plan, a family deductible is the amount your family must pay out-of-pocket before your dental plan starts to pay. A family plan usually includes a family deductible and an individual deductible for each member, contributing to the overall family deductible. The family's deductible is met when any combination of family members' healthcare costs meets the maximum deductible for the whole family. At that point, the family’s insurance plan begins paying their oral health care costs minus any coinsurance or co-pay, which is the family’s responsibility.

Suppose an individual meets their deductible before the family deductible is met. In that case, that person starts to receive their full benefits, while other family members still need to pay towards their individual deductibles. Once the family deductible is met, however, everyone in the family, regardless of whether they met their individual deductibles, will receive the full coverage benefits. For example, if your family with five members' deductible is $200, each with an individual deductible of $50, then meeting the individual deductibles for four members will satisfy the family deductible. 

Family deductibles versus individual deductibles

Family and individual deductibles are two types of deductibles that can be found in dental and health insurance policies.

  • An individual deductible is the amount an individual must pay out-of-pocket before their insurance coverage starts.
  • Family deductibles typically include individual deductibles for each family member. Family deductibles are higher than individual deductibles because they cover multiple people. Each individual family member’s coverage starts when their individual deductibles are met; however, when sufficient family members meet their deductible to satisfy the family deductible amount, all family members can receive benefits regardless of meeting their individual deductibles.
  • Be sure to read your plan details, as how deductibles are applied may vary between insurance plans.

Additional resources