The painful truth is that the cost of braces can be prohibitive. It is usually best to have at least some of the cost of orthodontic treatment picked up by a dental insurance plan or orthodontics insurance. Unfortunately, the percentage of the cost of braces which most dental insurance plans cover is small. We discuss the issues that should be considered before purchasing orthodontics insurance.
Are braces a medical necessity or a cosmetic procedure?
Most health insurance companies use the criterion of medical necessity to determine whether or not they will reimburse their customers for a particular procedure. An urgent appendectomy (appendix removal) will be covered but liposuction will not; the former is medically necessary while the later is simply for aesthetic appeal. A similar argument is used in dental insurance. How much of dentistry is medically necessary and how much is simply to look better? While it is reasonably easy to justify orthodontics treatment as a necessary procedure, it can also be argued that it is primarily cosmetic in nature.
Choose wisely
The bottom line is that basic dental insurance plans usually do not cover the cost of orthodontic treatment. If you know that you or your child is going to need braces at some point, first you should have dental insurance and second, make sure that orthodontic insurance is part of the plan. Some dental insurance plans allow the option of adding orthodontic insurance. This will increase the cost of the dental insurance premiums considerably. It is important to determine if the increase in premiums is higher than simply paying for orthodontic treatment out-of-pocket.
In and out
Many dental insurance companies are organized like PPOs (Preferred Provider Organizations) for medical insurance. This means that the insurance company has a number of preferred dentists that agree to do work for a certain negotiated price for insured patients. The dentists, in turn, expand their practices by accessing a larger number of patients through the dental insurance plan. This works well for dentists that are in the network of preferred providers, but what happens if you want to see someone that is not in this preselected group of dentists? Most orthodontic insurance companies will still reimburse part of the cost of “out of network” orthodontic treatment, but you are responsible for the rest (and will likely pay more).
Lifetime maximums
Many dental insurance companies want to limit their own costs by setting lifetime maximums for orthodontic insurance. This means that they will pay for the cost of orthodontic treatment up to a certain maximum amount determined in the original contract. Once the insured reaches that maximum amount, he or she is no longer eligible to receive any more payments for orthodontia. Why would a dental insurance company do this? Say an employee is covered by orthodontic insurance through his employer. The employee has eight children who are also covered under the plan. If eight kids need braces, the insurance company takes a bath. A lifetime maximum on orthodontic benefits keeps this from happening.
Orthodontic discount programs
So what do you do if you have a large family with crooked teeth? Orthodontic discount programs may provide the answer. To meet the needs of large (and small) families, orthodontic discount programs are a way to reduce the cost of orthodontic treatment for a many people. While it is not cheap, it does relieve the burden somewhat. For example, a person pays a modest yearly premium out of his own pocket, say $100 per year. As a benefit of the orthodontic discount, each person that receives orthodontic treatment under the plan gets a percentage discount on the total fee, say 20%. Considering the cost of braces this can represent a huge savings, especially for families with a large number of children that need orthodontic treatment. In these cases, though, there is no “out of network” orthodontists; you must have treatment with a preferred provider.
Flex your spending muscle
How many people divert money to their flexible spending account only to lose it at the end of the fiscal year? Whether medical or cosmetic, your flexible spending account can be used to pay for orthodontic treatment. Instead of letting that money disappear, remember that this tax-advantaged money is sitting there waiting to be spent on qualifying expenses (like braces).
Become a board case
While this may sound like a bad thing at first, it can actually save you money. Recall that to become a board certified orthodontist that it requires the successful completion of about 30 months of training after graduation from dental school. Along the way, a dentist will need to acquire experience in performing orthodontic treatment and be able to document it. If you agree to be a model patient whose teeth demonstrate the dentist’s skill as an orthodontist, the price break for you can be significant. Think this is like being a guinea pig? Consider this: if you do become a board case with photos of your orthodontic treatment on display as proof of the dentist’s prowess, don’t you think it will be excellent work?