Will orthodontic coverage completely pay for braces?

Orthodontic coverage typically involves a Lifetime Maximum Benefit (LTM) that pays out at 50% of the total case fee. There are a few plans that pay more or less than 50%. This means they will pay for braces 1 time and once you have used all of the LTM they won’t pay any more. If your LTM benefit is $3000, then braces would have to cost $6000 in order for you to use your full benefit. You would pay the difference between what your insurance covers and the total case fee.

Your out of pocket expenses can vary depending on whether or not you choose an in network provider. If your employer changes plans while you or your child are still in treatment the orthodontic payment history will typically follow you. However, if you take out a new plan with a completely different company often times, the history does not follow you and this can result in additional benefits. Anytime your insurance changes be sure to let your providers know.