When it comes to your dental insurance policy, there are several terms that refer to a maximum that can be easily confused with each other: out-of-pocket maximum, annual maximum, and orthodontic lifetime maximum.
We’ve discussed out-of-pocket maximum and annual maximum, but what is a lifetime orthodontic maximum and when does it apply?
Orthodontic lifetime maximum – According to Dr. Thomas Redd, DDS: “Your maximum insurance benefit towards orthodontics is reduced whenever you undergo any orthodontic treatment. Unlike most insurance coverage, which has annual maximum benefits that renew each year, orthodontic benefits are usually lifetime maximums. This means that once you use the benefit, there is no more coverage and it will not renew. If you go through multiple phases of orthodontic treatment, like some youth do, whatever insurance benefit is used in the first phase will reduce what is left for the second phase of treatment.
For example, if your child has one front tooth that is behind a lower front tooth (called a cross bite or sometimes a scissor bite) a dentist may make a simple retainer to correct it. Whatever the insurance pays towards that retainer, will go against or reduce the amount available for full braces when they might be needed in a few years.”
How much will I pay for an orthodontic treatment?
The orthodontic lifetime maximum amount can vary depending on your plan and provider, so it’s a good idea to review your plan coverage before you or your child needs orthodontics. Many plans will also cover a fixed percent of orthodontics in a plan year. In this case, your insurance provider will cover a set percent or the lifetime maximum, whichever is less. Here is an example of how that would look if you or a child needed braces:
Cost of braces: $5,000
Dental plan covers 50% of Orthodontics in plan year: $2,500
Orthodontic Lifetime Maximum: $3,000
Your plan covers the lesser, in this case $2,500. You are responsible for the other $2,500, and the remaining balance of your orthodontic lifetime maximum is $500.
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