While many preventative (cleaning and exams) and restorative (fillings and crowns) benefits reset on an annual basis, the majority of Orthodontic plans utilize a LIFETIME benefit. For example, if your plan has a $2,500 Orthodontic benefit, that is the total amount that can be used for each individual in a lifetime. It does NOT reset every year (i.e. If your plan has a $2,500 benefit, you do NOT get $5,000 of benefits over 2 years).

Unlike restorative or preventative procedures, the Orthodontic benefit is not paid in a lump sum to the Orthodontic office. For example, if you have a $2,500 benefit, your insurance company will not pay that amount as a lump sum when treatment starts; most insurances will typically pay the benefit in monthly or quarterly payments, spread out over 18-24 months. Therefore, it is essential that you maintain your Orthodontic insurance plan for the entire duration of treatment. If you drop the plan (voluntarily or through change/loss of employment), the remaining balance that insurance did not pay out will become your financial responsibility.

In the event that you are changing insurance plans while still in the middle of treatment, it is essential to know if the new insurance plan covers “Work In Progress” for Orthodontics. If the new insurance plan does not cover Work In Progress, then they will not pay any benefits for Orthodontic treatment. If there was a remaining unpaid balance from the previous insurance company, that amount will then become your financial responsibility. In scenarios where the new insurance DOES cover Work In Progress, note that they might not pay the full lifetime benefit as stated in their plan; instead they will often pro-rate the amount of benefit, based on the number of months already in treatment versus the months remaining.