It is very common for individuals who have upcoming dental appointments (especially major procedures) to have some uncertainty regarding what aspects of the procedure will be covered by insurance and what they will be responsible for paying. When it comes to understanding your MetLife dental insurance, there are three terms that will come up often: copay, deductible, and coinsurance. It is important to have a clear understanding of what each of these terms mean, and doing so will allow you to know how your plan splits costs between you and the insurance company. and knowing how they work can make a big difference in managing your dental expenses.
A copay is a flat fee you pay for a service at the time of your appointment. For example, you might owe $20 for a check-up or $50 for a more complex procedure. In DHMO (Dental Health Maintenance Organization) plans, these fees are clearly laid out in a schedule. Many people find this helpful because they know in advance what they’ll need to pay. If you’re someone who likes to budget closely, the predictability of copays might be an advantage.
A deductible is the amount you need to pay out of pocket each year before your insurance starts contributing to most treatments. For example, if your deductible is $75, you’ll pay that amount first—then your plan kicks in. In many PPO (Preferred Provider Organization) plans from MetLife, this deductible only applies to services beyond preventive care. Routine cleanings and exams are often covered 100%, even before you meet the deductible.
Coinsurance comes into play after your deductible is met. It’s the percentage of the bill that you are still responsible for. For instance, if your plan pays 80% of a filling, you’ll owe the remaining 20%. Some people are surprised to learn that not all services are paid the same way—basic procedures might be covered at a higher rate than major ones like crowns or dentures.
It’s also important to know about your annual maximum—the most MetLife will pay in a given year. Once you reach that cap, you’re responsible for any extra costs. That’s why it helps to plan major procedures carefully or split them across plan years if possible. Preventive care usually does not count toward this limit, so there’s no reason to delay your regular visits.
What makes navigating all this easier is MetLife’s online portal. There, you can look up your benefits, see how much of your deductible or annual maximum you've used, and even estimate what a treatment might cost. If you’re ever unsure, your dentist’s office can often help clarify your benefits—or you can call MetLife directly.
These terms might sound technical at first, but they’re the foundation of how dental insurance works. Once you get the hang of them, it becomes much easier to plan your care and avoid unexpected bills. Whether you're new to dental coverage or just brushing up, knowing what to expect can help you feel more in control of your dental health.
To learn more about coverage and treatments, contact us.