Dentists/Orthodontists

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Orthodontic coverage is often a separate benefit in a dental insurance contract. Coverage's for orthodontic treatment usually are at the 50% level.

This is a complicated question. Orthodontic insurance is separate from medical and dental. If you have dental insurance, most likely you have orthodontic benefits. Orthodontic benefits are separate from your normal dental insurance with your dentist. Orthodontic benefits are paid over the course of the treatment for the patient and normally have a lifetime maximum or co-pay per patient. The normal time for braces is 24 months. In that case, your benefit would be paid over 24 months. Only 1% of insurance companies pay your orthodontic benefit in full in one payment. There are medical plans that have orthodontic benefits only if the braces are medically necessary and your plan includes orthodontic benefits. See below for examples of different scenarios.

The most common benefit is payable at a percentage with a lifetime maximum of a certain amount. For example: payable at 50% with a lifetime maximum of $1500 per person. Let us say the total charge for braces is $6000. The insurance company covers 20% down when the braces are put on: $1200 and this is covered at 50%. The insurance company will pay $600 when you get the braces on and you are responsible for the remaining 50%: $600.00. The remaining balance of $4,800 is divided by 24 months (the course of the treatment): $200 per month. The insurance company pays this amount at 50%, which is $100 per month until you have reached your maximum benefit. In this case it is $1,500. If you take the $1,500 minus the $600 paid at the banding date of the braces and $100 per month thereafter, you will run out of benefits in 9 months. After the 9th month your responsibility would be the full $200 for the remaining months instead of the $100 per month for the first 9 months. In reality, the braces are $6,000 minus your $1,500 benefit with a remainder of $4,500 that is your responsibility.