Dental copayment (copay)

A fixed dollar amount you pay for a covered service. Aetna describes it as a set dollar amount, and Humana says set copays mean you know upfront what basic and major services will cost. It differs from coinsurance, which is a percentage of a fee.

A copay is a set dollar amount, and coinsurance is a percentage. Aetna describes both in its DMO explanation, and UnitedHealthcare defines coinsurance as the percentage of covered expenses you pay after the deductible. Ask your plan which applies to each service.

Sometimes. Cigna's comparison says a DPPO sometimes has copays, while a DHMO typically does, and Guardian says its PPO plans have copays for major dental care. Check your schedule of benefits to see which services carry a copay and which use coinsurance.

Often, on many plans. Humana says preventive services have a zero copay on its Dental Value plan, and UnitedHealthcare says some plans require a copay for preventive services while others cover them in full. Your schedule of benefits lists the exact terms and any yearly limits.

In your plan's fee schedule or benefit summary, which lists the copay for each procedure. Ask your plan or your employer for it, or check the member website. Ask the dental office to confirm which code it will use.

It depends on the plan. Some copays include the laboratory fee and others do not. Ask your plan and the office before treatment, and get the total in writing. This matters for crowns, bridges and dentures, which involve laboratory work.

It usually stays the same during the plan year, and may change at renewal. Ask when the schedule was last updated and whether the office's fees changed. Keep a copy of the schedule that applied when you agreed to treatment.

Specialists may have their own schedule, and some plans charge more for specialty care. Aetna says its DMO needs a referral for specialists, except orthodontists. Ask your plan what a specialist visit costs, and check that the specialist is in the network.

On plans with an annual maximum, the plan's payments count and your copays generally do not. DHMOs usually have no annual maximum, according to Cigna, Humana and Aetna. Ask your plan how it works, and track what you have paid.

Ask the plan how it will be charged before treatment. It may be covered at a different level, or billed at the dentist's usual fee, or excluded. Ask for the answer in writing. A pretreatment estimate can settle it.

No. Each plan has its own schedule, and the terms vary by state and by carrier. Compare the schedules of any plans you are considering, for the services you expect to need.

A DHMO's copays make costs predictable and often lower, while a PPO shares costs by percentage and adds a deductible and an annual maximum. Humana says a DHMO is not necessarily better. Compare both against the treatment you expect and check the network.