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?
What is an orthodontic lifetime maximum?
According to Dr. Thomas Redd, DDS a “lifetime maximum orthodontic benefit is just like it sounds. Your maximum insurance benefit towards orthodontics is applied 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, 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 on 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 braces. 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: $5000
Dental plan covers 50% of Orthodontics in plan year: $2500
Orthodontic Lifetime Maximum: $3000
Your plan covers the lesser, in this case $2500
You are responsible for the remaining $2500
Remaining balance of Orthodontic Lifetime Maximum: $500
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