# [2010] Dental Insurance and Orthodontic Question



## Fitzriley (Mar 3, 2010)

I have no dental insurance since changing jobs 2 years ago. We have been paying for our care as we go. 2 adults, 2 children, 2 cleanings each per year and x-rays. It has run us about $1,200 for the year and is less expensive that paying for dental insurance. Now my 9 year old son has been referred to an orthodontist for "crowding" problems with his teeth. Top teeth are just beginning to turn due to his small mouth. I have no experience with braces or retainers, as he is the first in the family to need this type of care. I am now wondering if I should look into dental insurance. Does it even cover orthodontia? 

Any information would be helpful. 

Thanks,
Joan


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## Luanne (Mar 3, 2010)

Our dental kind of covered orthodonia.  What it provided was a "cap" on any orthadontia work, per person.  I think it was something like $1500.  When our dds got to the point of needing braces we took out dual dental converage (both dh and I had it).  It was suggested by the orthodontist's office.  That way $1500 was used from my dental plan and $1200 from dh's.  The total cost of the braces was somewhere around $4800 - $5000, so we still had a substantial amount out of pocket.


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## JustAllie (Mar 3, 2010)

Fitzriley said:


> I have no dental insurance since changing jobs 2 years ago. We have been paying for our care as we go. 2 adults, 2 children, 2 cleanings each per year and x-rays. It has run us about $1,200 for the year and is less expensive that paying for dental insurance. Now my 9 year old son has been referred to an orthodontist for "crowding" problems with his teeth. Top teeth are just beginning to turn due to his small mouth. I have no experience with braces or retainers, as he is the first in the family to need this type of care. I am now wondering if I should look into dental insurance. Does it even cover orthodontia?
> 
> Any information would be helpful.
> 
> ...


It varies by policy, and there are usually limits on the amount it will cover, particularly for something like orthodontia.  But sometimes it's still worth getting simply so that you can access network discounts.  

Do you have a medical flexible spending account (FSA) at your workplace?  Sometimes it makes more sense to use that mechanism, since dental insurance is so expensive relative to the value you can receive from it.


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## klynn (Mar 3, 2010)

Our insurance covers $1,500. for orthodontia per child.  Total orthodontia treatment per child was $5,500-6,000.


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## Luanne (Mar 3, 2010)

klynn said:


> Our insurance covers $1,500. for orthodontia per child.  Total orthodontia treatment per child was $5,500-6,000.



This sounds very much like ours.  Which is why I was so pleased when the orthodontist's office suggested we get the dual coverage if we could.


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## Patri (Mar 3, 2010)

I was surprised we could use dual coverage too, which happened with an overlap of jobs. We have to figure out if the payout is worth it with cobra now, but neither company cares, and they know about the other.
Coverage isn't as great as it used to be. One is $1,000, the other slightly more.


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## Luanne (Mar 3, 2010)

Patri said:


> I was surprised we could use dual coverage too, which happened with an overlap of jobs. We have to figure out if the payout is worth it with cobra now, but neither company cares, and they know about the other.
> Coverage isn't as great as it used to be. One is $1,000, the other slightly more.



We've kept the dual coverage even now, long after the braces.  It helps since all of us in the family get our teeth cleaned more than the standard two times a year.  So the secondary dental insurance pays for those additional cleanings.  The coverage isn't great, but the premiums aren't terrible.


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## DJensen (Mar 3, 2010)

*Dual Coverage Details*

Be certain to check the details of the orthodontia coverage because as I looked into adding seconday coverage the carrier said that they look for other payments (coordination of benefits) and often times will not pay the "second" limit. Not certain how accurate the claims documentation and whether the carrier would have caught it, but opted not to try it based on the premium expense.

We aslo had a orhodotist business manager tell us that it was no problem to use them for care, once I looked into the detials they were not participating in our plan and we could have been on the hook for anything above "contract" prices. (We ended up with a particpating provider, they handle the billing, payments and we don't have any other obligation based on the care plan).


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## pjrose (Mar 3, 2010)

Our coverage was similar to Luanne's - about 1,000 lifetime maximum per child, as I recall, and the total cost ended up between $3,000 and $5,000 depending on the child.

The orthodontist's office was very helpful with a payment plan, discount for prepayment, and no additional cost for additional visits that were needed for assorted issues.  

Some words of warning - after going through the cost and discomfort of orthodontia, BE SURE your child follows through by wearing the retainer.  DS didn't, and his teeth are as crooked as they were before (teeth can be moved, and they can move back).  DD does, and her teeth are nice and straight.  Also, BE SURE the child brushes, flosses, uses a waterpik etc as recommended; the orthodontic hardware creates lots of lovely places for bacteria to do their thing, and DD ended up with quite a few small cavities on the fronts of her teeth from the brackets.  Her teeth look nice now - straight from wearing the retainer, and bright from bonding (expensive) of all the front surfaces.


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## Luanne (Mar 3, 2010)

pjrose said:


> Our coverage was similar to Luanne's - about 1,000 lifetime maximum per child, as I recall, and the total cost ended up between $3,000 and $5,000 depending on the child.
> 
> The orthodontist's office was very helpful with a payment plan, discount for prepayment, and no additional cost for additional visits that were needed for assorted issues.
> 
> Some words of warning - after going through the cost and discomfort of orthodontia, BE SURE your child follows through by wearing the retainer.  DS didn't, and his teeth are as crooked as they were before (teeth can be moved, and they can move back).  DD does, and her teeth are nice and straight.  Also, BE SURE the child brushes, flosses, uses a waterpik etc as recommended; the orthodontic hardware creates lots of lovely places for bacteria to do her thing, and DD ended up with quite a few small cavities on the fronts of her teeth from the brackets.  Her teeth look nice now - straight from wearing the retainer, and bright from bonding (expensive) of all the front surfaces.



Agree, agree, agree.


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## mo1950 (Mar 3, 2010)

My grandson's father was supposed to keep dental insurance on him, but canceled it.  When he looked into signing up again, his policy stated he had to have the dental policy in effect for 2 years before it would begin covering orthodontics.

To make a long story short, my grandson had to have the dental work immediately before he grew any more, so it is being paid for out of pocket.  He is having extensive orthodontics and the total cost for a 2 year treatment is $4,000.  The orthodontist required $800 down payment and then a payment of approximately $175 a month for two years.

The reason I posted is that you might want to make sure how long the dental policy has to be in effect before it covers orthodontic expenses.

I wish you the best of luck and hope you find insurance that will cover right away.


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## Rose Pink (Mar 3, 2010)

pjrose said:


> Some words of warning - after going through the cost and discomfort of orthodontia, BE SURE your child follows through by wearing the retainer. DS didn't, and his teeth are as crooked as they were before (teeth can be moved, and they can move back).


Ditto.  DD did not and now she is undergoing adult orthodontia--at her expense this time--and adult ortho is not covered by insurance.


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## rosebud5 (Mar 3, 2010)

My dental insurance gives me a discount ($4,800). I think I pay $36/month for dental insurance, for a family option. I think that is cheap. My youngest daughter had to go to the orthodontist twice (ouch). I always felt ripped off for the first one. The second time really straightened out her teeth and took almost four years to complete. All through high school, yes it was very traumatic. Total cost including oral surgery was $9,200 for both treatments. We payed for that over a number years.

Currently, the wife and I both need crowns and the insurance will save us about $150 each. Well worth it.


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## Fitzriley (Mar 4, 2010)

Thanks for all the advice. The dental plans I have seen would cost me about $1500 for the year, so I am not sure it is worth it, especially if there is a waiting period for orthodontia. I guess I'll see what the ortho thinks first and then decide how to handle the finances. I am hoping for a night retainer only rather than braces. 

joan


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## thheath (Mar 6, 2010)

A previous poster is correct that most dental insurance compainies require a minimum of 12-24 months on the policy before they will pay for braces, caps, etc.


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## swift (Mar 6, 2010)

I am also interested in this topic. I have dental insurance through my employer. We are covered 100%. However, they do not cover any orthodontics and my youngest really needs them.


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## pkyorkbeach (Aug 25, 2011)

A dental policy here at work covers braces of $600.00 per person max  lifetime...when you figure the monthly dental cost it is cheaper to pay braces yourself...

when both of my children had braces I had a payment plan. Like a car payment not too bad....


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## CapriciousC (Aug 25, 2011)

swift said:


> I am also interested in this topic. I have dental insurance through my employer. We are covered 100%. However, they do not cover any orthodontics and my youngest really needs them.



We're in a similar situation.  We have what I would otherwise consider to be great dental coverage (DD and I both get cleanings 3X a year as opposed to two, and we never pay out of pocket, and other stuff like crowns, etc. is usually covered on the order of 75-90%).  However, the orthodontic coverage is paltry at best.  DD is only 7, so we hopefully have a few years before the expense will hit, but I expect we'll be paying the vast majority out of pocket.


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## xzhan02 (Aug 25, 2011)

The biggest saving might be  the in network cost through insurance.  My daughter's orthodontist charges $5000 without insurance, but only $3300 with our Aetna insurance, which pays $1500 max out of the $3300.




pkyorkbeach said:


> A dental policy here at work covers braces of $600.00 per person max  lifetime...when you figure the monthly dental cost it is cheaper to pay braces yourself...
> 
> when both of my children had braces I had a payment plan. Like a car payment not too bad....


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## thickey (Aug 25, 2011)

My wife is a dentist.  I have not read each reply in this thread, so someone may have already covered this...
There is a thing called Care Credit www.carecredit.com.  You can apply for this to pay for orthodontia as well as most other dental/medical needs.  If I remember correctly, there is no interest for 18 months or something. They will pay your bill, and you can make monthly payments to them.  Almost everyone can qualify.  Check it out!  Hope it helps.


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## kewanee (Aug 25, 2011)

If your child is only 9, they might need ortho now and then again later after
all their permanent teeth are in.  Make sure the orthodontist gives you all the pros and cons of waiting or doing the work now.  My 3 kids all needed 'standard' ortho and it cost $6000 each (Northern California).   The good news - we had a good dental plan which paid $2500 towards the first two.  Also, the ortho office lets you make no interest payments spread over the expected treatment (2 - 3 years).


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## Icc5 (Feb 4, 2012)

*We were lucky-suggestion*

When my kids were young we were lucky because both my wife and I had Delta Dental and the double coverage covered all expenses except for one set of e-rays on each kid.  Today the same insurance has a cap and only would partically cover.
My suggestion is to talk to your dental person where you would go.  Find out what the cost would be from them and if they would suggest you get insurance or pay out of pocket.  They might even be able to suggest an insurance that works well with them.
Bart


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## wackymother (Feb 4, 2012)

We have Delta Dental, too, but there are different plans. Our cap on each kid for orthodontia was $500. 

We got a discount on the first child for paying up front, in cash. Then for the second kid, the orthodontist had a summer special that worked out for us--it was 10 or 20 percent off if you had the braces fitted in July or August, when most children were away on vacation. So you might ask if the orthodontist offers any kind of discount. 

If you're not really attached to your orthodontist, you can shop around. Some are less expensive than others. For various reasons, we wanted to use a certain guy, and he's great, but he is definitely more expensive than some other orthodontists in the area who came highly recommended.


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## stmartinfan (Feb 4, 2012)

pjrose said:


> Some words of warning - after going through the cost and discomfort of orthodontia, BE SURE your child follows through by wearing the retainer.  DS didn't, and his teeth are as crooked as they were before (teeth can be moved, and they can move back).



I strongly endorse getting the "permanent" retainers after completing braces if possible.  Instead of the retainer that slips in and out, permanent ones are small bands that are glued to the backs of the teeth.  They are left in place for several years after the braces until you pass the time when there's the likelihood of teeth moving out of alignment.  They cost a bit more but there's no risk of loosing or forgetting to wear.  Both our daughters have them and neither has ever complained about them.  The only negative is having to be extra careful with brushing the backs of the teeth to keep them clean and having to use a "threader" to floss.  

Both daughters' teeth still look wonderful after nearly five years out of braces.  

Another comment on costs...At least for us the Ortho bill didn't cover the cost to do extractions.  Both girls needed to have some teeth pulled and for that we had to go to an oral surgeon.  Most of that was covered by our dental plan and was n addition to the amount they set for braces.  One daughter also need minor surgery to trim the gum area between her two front teeth, because it was too large and prevented her front gap from closing


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## DeniseM (Feb 4, 2012)

Please note that this question was posted in 2010, and it was brought out of mothballs by a spammer, whose post has been deleted.


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## nightnurse613 (Feb 4, 2012)

But, apparently, there is some interest once again!!  There are several companies here in Phoenix that sell a PLAN (versus INSURANCE).  The plan is under $100 for a single person and it lets you use negotiated rates versus standard rates.  They don't pay ANYTHING and you pay $100 for the privilege of using the negotiated rate - which you could probably negotiate with the dentist anyway.  Just saying.  Also, I have seen two Groupons in the last couple of months advertising Invisalign for $2700 (that's about half price) but it's ALL UP FRONT versus the payment plan some have mentioned. By the way, thanks for the tip about permanent retainers!   As a side note, why don't we close threads after a certain time?


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