How much does insurance cover for braces?

[5 Disney Fans]

I took my DD for a orthodontist consult and was told she will need braces. They are suggesting phase 1 of possibly two phases to correct her "issues". She has overcrowding and a crossbite. She has only lost about 8 baby teeth but the adult ones that came in are a mess. Phase one is a palet extender and braces on her four top front teeth, that will be $3K If that doesn't correct it then phase two will be a full set of braces.

The orthodontist told me that our insurance has a lifetime cap of $800 for braces. As you know that is a drop in the bucket especially if she needs two phases. I don't opt into my insurance at work since we are all covered under my husband's plan, but I'm wondering if it would be more cost effective to pay into my healthplan if they would cover more of the cost or orthodontics.

Just wondering what other people's carriers cover for braces.

 

[crisi]

Mine covered $1500 per person - for phase 2 we switched to my husband's to get another $1500 - they wouldn't stack (i.e. I couldn't get $3000 for phase one), but they would pay in subsequent claims.

 

[phewms]

Under 18 years old, insurance covers 100%.
Over 18 years old, insurance covers 0%.

 

[Darcy03231]

$2500/pp lifetime max

 

[NYCDiane]

It depends on your insurance. When my DD got her braces, the insurance covered 50% and I had to pay the other 50% out of pocket

 

[alaskanabbott]

our insurance covered $4000 per person, doesn't matter their age. We paid about $1000 each kid OOP. I'm getting braces myself in January and my OPP will be about $900

 

[Pigeon]

Call your HR office and ask. What our plans covered is immaterial to what your plan covers.

My kids have dental both through my union plan and my husband's dental plan. They each paid roughly $1500 for orthodonture. We opted not to do the whole nine yards ($8K) that the ortho pushed, and went for a more moderate approach that gave excellent results and cost $1500.

 

[wiigirl]

Under 18 years old, insurance covers 100%.
Over 18 years old, insurance covers 0%.

Good insurance!

 

[crisi]

Call your HR office and ask. What our plans covered is immaterial to what your plan covers.

My kids have dental both through my union plan and my husband's dental plan. They each paid roughly $1500 for orthodonture. We opted not to do the whole nine yards ($8K) that the ortho pushed, and went for a more moderate approach that gave excellent results and cost $1500.

She knows - its $800. I think she's trying to figure out if she has decent insurance, because there is the option of switching from her husband's plan to her plan.

And at this point, its worth looking at her benefits and delaying until she can enroll in her plan if the benefits are better.

Also, OP, you should know that there usually isn't a burning need for two phase braces. My daughter had them, and something like 80% of kids who have phase one will need phase 2. If you skip phase one and wait, phase two will take longer - but its rare that there are issues that REALLY should have been fixed by phase one braces. For us, two phases wasn't a financial stretch - if it is for you, get a second opinion on two phases. Orthodonists love it - its more money for them - and frankly, I loved having my daughters teen set on for less than a year - but its an expensive choice.

 

[Pigeon]

She knows - its $800. I think she's trying to figure out if she has decent insurance, because there is the option of switching from her husband's plan to her plan.

And at this point, its worth looking at her benefits and delaying until she can enroll in her plan if the benefits are better.

Also, OP, you should know that there usually isn't a burning need for two phase braces. My daughter had them, and something like 80% of kids who have phase one will need phase 2. If you skip phase one and wait, phase two will take longer - but its rare that there are issues that REALLY should have been fixed by phase one braces. For us, two phases wasn't a financial stretch - if it is for you, get a second opinion on two phases. Orthodonists love it - its more money for them - and frankly, I loved having my daughters teen set on for less than a year - but its an expensive choice.

The $800 is the current insurance, on her husband's plan. She should call HR where she works to see what the coverage would be if she goes with that.

 

[sksjasams]

We have Delta Dental and they pay $1500 lifetime max. Our portion was about $4k. I spoke to a mom at school who has her insurance and her DH has his insurance, and between the two, they paid nothing out of pocket for two kids in braces. Not sure how that works, if one is considered primary insurance and the other secondary, but they both apparently paid. It would definitely be worth looking into your insurance at work, seeing if one is better or if they can be stacked.

 

[grassmower]

Our dental insurance pays a grand total of $0.00 for orthodontics.

 

[thebeesknees]

Ours paid $1,000 total lifetime max, but only for dependents under 18, so for DH (whose mouth was an absolute mess and needed braces for 3 years) we had to pay the whole $9,000 OOP - ouch! DS just got a palate expander, the braces will go on later. Just the palate expander came to $1900, I don't know how much the braces will come to.

 

[McKelly]

Our insurance pays $1000.00 per person lifetime for orthodontics. Braces were $5600.00 for my DD, so $4600.00 OOP. My DS had Phase 1, which was $1800.00, so $800.00 OOP. Hoping he doesn't need Phase 2.

 

[cari12]

I took my DD for a orthodontist consult and was told she will need braces. They are suggesting phase 1 of possibly two phases to correct her "issues". She has overcrowding and a crossbite. She has only lost about 8 baby teeth but the adult ones that came in are a mess. Phase one is a palet extender and braces on her four top front teeth, that will be $3K If that doesn't correct it then phase two will be a full set of braces.

The orthodontist told me that our insurance has a lifetime cap of $800 for braces. As you know that is a drop in the bucket especially if she needs two phases. I don't opt into my insurance at work since we are all covered under my husband's plan, but I'm wondering if it would be more cost effective to pay into my healthplan if they would cover more of the cost or orthodontics.

Just wondering what other people's carriers cover for braces.

I would check with your HR dept as it probably would be worth it to have dual coverage.
Also, I would get a second opinion. You didn't say how old your daughter is and of course every case is different but my DS8 has crowding issues and our ortho recommended pulling his baby eyeteeth to give room for the adjacent adult teeth to come in. Then in a year or 2 when the adult eyeteeth come in, then we will re-visit the situation. That also gives his mouth a year or 2 to grow as well. The extractions were done by our dentist and fully covered by our regular dental plan. He will probably need braces in the future but this means we only do it once.
We have dual coverage so $2500 lifetime from my plan and $2500 lifetime from DH's plan.

 

[bigbabyblues]

The insurance we had when DS2 got his phase 1 braces paid $1000 lifetime. When DS1 got his a year later, our insurance plan (different plan) did not pay anything. We will also have to pay for phase 2 for DS2 under this insurance.

 

[TnTWalter]

Also!

Both my DDs got them last Spring. I received discount for paying in full and sibling discount. $9,000. Ouch.

 

[magsmum]

Our dental insurance pays a grand total of $0.00 for orthodontics.

Same here. Two older kids needed them and we are currently paying off child #2's second phase of treatment. Child #3 is being followed by orthodontist and she is definitely another two phaser.

Fortunately our orthodontist does give teachers a slight discount in recognition of how poor our benefits are in general.

 

[magsmum]

Our dental insurance pays a grand total of $0.00 for orthodontics.

Same here. Two older kids needed them and we are currently paying off child #2's second phase of treatment. Child #3 is being followed by orthodontist and she is definitely another two phaser.

Fortunately our orthodontist does give teachers a slight discount in recognition of how poor our benefits are in general.

 

[memy26]

Our dental insurance pays a grand total of $0.00 for orthodontics.

Sadly this is ours too, and both kids need braces