📋 Cost Estimators

Copay & Deductible Calculator

Enter your procedure cost, coverage percentage, and deductible status to calculate exactly what you'll pay. See the full cost breakdown step by step.

Step-by-Step Breakdown Deductible Logic Annual Max Check PDF Export
Copay & Deductible Calculator
Understand exactly what you'll pay before your appointment
Procedure Details
$
Your Plan
%
80% for basic, 50% for major on most PPO plans
$
Leave $0 if same as dentist fee (in-network). Enter if plan has a lower allowed amount.
$
$
$
$

📋 Cost Breakdown

Total Fee
-
Dentist charges
Insurance Pays
-
After deductible & max
YOU PAY
-
Out-of-pocket total
Disclaimer: This estimate assumes in-network fees unless an allowed amount is specified. Actual costs may vary based on plan specifics, frequency limitations, waiting periods, and whether the procedure requires pre-authorization. Always request a pre-treatment estimate from your insurance carrier.

How dental copays and deductibles actually work

A deductible is the amount you pay out-of-pocket before your insurance starts paying its share. On most dental plans, the deductible is $50-$100 per year and applies only to basic and major procedures - preventive care is usually exempt. Once you've met your deductible for the year, your insurer pays its coverage percentage on subsequent eligible costs.

The copay is the percentage you pay after the deductible. On an 80% basic coverage plan, after the deductible you pay 20% of the allowed amount. But there's a complication: many plans set an "allowed amount" lower than what your dentist charges. If your dentist charges $500 for a root canal but your plan's allowed amount is $400, you pay your 20% of $400 plus the full $100 fee difference. This is why in-network dentists matter - they've agreed to the plan's allowed amounts.

For a broader view of your annual coverage, use the Dental Insurance Calculator. To plan treatment across multiple years to maximise benefits, see the Annual Dental Budget Planner.

Frequently Asked Questions

A copay is a fixed dollar amount you pay per visit regardless of the procedure cost ($20 for an exam, for example). Coinsurance is a percentage of the procedure cost you pay after the deductible (20% of a $500 filling = $100). Most dental plans use coinsurance rather than copays. This calculator handles coinsurance - the percentage model used by most PPO dental plans.
In-network dentists have signed contracts agreeing to accept the insurance company's allowed amount as payment in full. Out-of-network dentists set their own fees and aren't bound by your plan's allowed amounts. When an out-of-network dentist charges $600 for a procedure your plan allows $400, you're responsible for the $200 difference plus your coinsurance percentage. This is why staying in-network typically saves significant money.

Related Tools