Are We Losing Money On Our Dental Plan Because of Orthodontic Coverage for Our Children?

A few years ago, my husband’s employer was taken over by another company. It didn’t take long for the benefits to get cut: we went from having good dental and medical coverage, and high life and disability insurance to being told we could buy selected benefits using a “shopping cart” funded with a percentage of his annual salary. Sound familiar to anyone else? Anyway, while reading the benefits info again recently, I began to wonder if we are actually losing money on the orthodontic coverage provided for our children.

Dental Plans May Strictly Limit Reimbursement for Orthodontic Work

The problem for the insurance company is that orthodontic work is expensive. It’s also becoming very common: to the point where no one teases kids about their braces any more because they see them on teeth in dozens of mouths. In fact when one of my children’s friends had braces put on, many of her classmates didn’t notice, and even when they did they couldn’t remember if she’d had them on for a year or if they were new.

So to reduce how much dental insurance plans have to pay out, or conversely to keep from having to raise the premiums unacceptably high, many plans limit the coverage for orthodontic work.

Our plan pays nothing for orthodontic work for adults.

For dependant children, it has set a maximum lifetime claim of $1500 per child.

Have you checked the price for a regular course of treatment for orthodontic work? Let’s just say $1500 isn’t going to get you through the first appointment much less the following two years.

How Our Dental Plan and Premiums Work

Our dental plan has another interesting twist:

If you want ANY dental coverage for your child, you have to insure all of your children and you must pay the orthodontic premium for each child.

That sounds reasonable at first glance: they don’t want you only paying premiums for your child with enamel problems and teeth coming in everywhere but where they are needed, and not paying premiums for your three other children who have perfect teeth and never need even a filling or a polishing.

It’s when you look into the details of that “orthodontic premium for each child” that you wince.

And they charge an orthodontic premium for each year of your child’s life until they are 19.

How Much Premium Will I Pay for Orthodontics?

Under our plan, for our family, the orthodontic premium is currently $140.40 per year.

So someone with two children enrolled from birth till when the premiums stop being applied when each child turns 19, should expect to pay $2667.60 or more in premiums.

That doesn’t even assume that the premiums increase. For us, it’s increased, of course, even in the four years we’ve had this insurer from $111.36 to  $140.40 per year. That’s about a 26% which is well above the rate of inflation these past 4 years.

Will We Lose Money Paying Our Orthodontic Premiums for Our Dental Plan

If we had been enrolled in this plan for years, then yes, we would definitely have lost money. We would have paid over $2667.60 in premiums to get a maximum reimbursement of $1500 for our one child who needs orthodontics.

In our case, though, we were only forced into this plan when our children were older. Will we still lose money?

Yep. Assuming no further premium increases, and based on the actual premiums we’ve paid to date, we will pay $1508.64 in premiums to get back the $1500 for which our one child is eligible.


Benefits? Who called this beneficial? For us to have to give money to the insurance company?

I can just imagine how any employee feels who has several children who never need orthodontics!

Admittedly, there should be a benefit to someone who has several children who need orthodontic work done.

Why Would We Get Dental Coverage for Our Children If We’re Going to Lose Money on the Orthodontic Premium?

First, in our plan you can’t opt out of coverage for your children unless you can prove they have coverage under another plan. (I’m not sure whether you could fight this in a court or not.)

Second, the dental insurance also provides coverage for all of the other more routine dental work a child needs: cleanings, fillings, x-rays, examinations etc.

I believe we are saving money by having coverage for those procedures although I would have to start adding up our bills to be sure as our children have been blessed with very healthy teeth.

Well, at least we’re saving money–unless we could not convince our dentist to drop his billing rate…. Some dentists will charge less for the same procedure if you have no insurance. They don’t have to, of course, but they may.

Keep an Eye on Your Benefits and Make Sure They’re Benefitting YOU and Not the Insurer

This review has taught me that it’s important to keep an eye on our benefits. For example, if I was a younger parent I might very well be lobbying our HR department to make changes to this Orthodontic insurance premium. Like dropping it altogether!

I think I’d better check our Eye Health coverage next. Something makes me wonder if we’re breaking even on that coverage or not. And at least that coverage can be waived if we’re losing money!

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Join In
Do you ever check your benefits to determine if you’re paying more than you’re getting back? Have you successfully lobbied for changes in coverage? Please share your views with a comment.

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