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?
If your dental plan covers orthodontics, it likely has an orthodontic lifetime maximum. Your orthodontic lifetime maximum is the total amount your plan will pay toward orthodontic services over the course of a member’s lifetime.
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.”
How much will I pay on an orthodontic treatment?
The orthodontic lifetime maximum amount can vary depending on your dental plan so it’s a good idea to review your coverage before you or your child needs braces. Many plans will also cover a fixed percentage of orthodontics in a plan year. In this case, your insurance provider will cover a set percentage 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