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hominid's avatar

How is orthodontics covered in other countries?

Asked by hominid (4531 points ) March 20th, 2014

I have health and dental insurance. Despite paying $400/mo for this coverage through my employer (family plan), I still ended up paying an additional $8,000 in out-of-pocket costs last year for things that were not covered.

My daughter is about to start “phase 2” of her orthodontic treatment. Over the past couple of years, she has had a palate expander and had braces. The “phase 1” cost was $2500. My insurance covered $1000 of this. However, the maximum lifetime benefit per person for orthodontics is $1000. So, we just found out that “phase 2” will cost approximately $5700. None of this will be covered, and I have no idea how to pay for this. We are meeting with the orthodontist next week, and I suspect he will discuss financing options.

This cost is going to be a huge strain on my family. Plus I have 2 other kids. How can the insurance company justify a $1000 lifetime benefit?

Anyway, if you live in a sane country with a better health care system, what is your experience with orthodontic care? Is it covered at a higher level? Less?

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12 Answers

gailcalled's avatar

Factor into that question the items not covered in Medicare and Medigap insurance; issues for most senior citizens eventually.

No coverage for hearing aids; c. $4000 for the latest generation.
No coverage for perscription eye glasses; over $500 for bifocals with non-reflexive lenses.
No coverage for dental work; I just paid over $1400 for a root canal and all the attendant fixing out-of-pocket.

Judi's avatar

Have you watched BBC? I think orthodontics might not be covered at all in many European countries. ~

thorninmud's avatar

In France, the national Social Security system will reimburse about ⅓ of the cost (for treatment that starts before age 16). It’s common for people to take on private insurance that takes up the slack between the S.S. reimbursement and the actual costs. The different “complementary” insurance policies will vary in their level of coverage, but for not much money (by US standards) you can get a policy that will cover all of the difference.

hominid's avatar

Finding it difficult to breathe today since getting this news. Looks like today’s lunch will be a brisk walk with a side of meditation.

janbb's avatar

@hominid you can sometimes negotiate a lesser charge with a doctor if they know you are not being reimbursed. It doesn’t hurt to ask.

Stinley's avatar

Orthodontic treatment is available free on the UK NHS for under-18s who need it.

I read at first that you were having a side of medication rather than meditation. It may actually be necessary…

gailcalled's avatar

edit: “prescription”.

gailcalled's avatar

I am asking my daughter, who lives in British Columbia, what she can find out. Her boyfriend has three kids.

JLeslie's avatar

Dental insurance generally sucks in America, I am shocked any orthodontics (is that a word?) are covered.

GQ, I’ll be following. I’m interested in the answers.

dappled_leaves's avatar

Dental care in Canada is rarely covered by Medicare. Only a few orthodontic services are covered – essentially, only for “functional handicap”. I assume that braces would be considered aesthetic (never had them, myself).

People usually have personal dental insurance (or insurance through their employers) for this kind of thing. If you’re expecting to want orthodontic treatment for your family, you have to make sure that’s covered in your plan, or get a different plan. But I would assume that coverage is nowhere near as expensive as in the US. We also don’t have the kind of pressure you have regarding “pre-existing conditions”. If you find out you need braces, you’d likely go out and get an insurance plan immediately, then get the braces done after some brief waiting period.

trailsillustrated's avatar

Australia: Under medicare for certain under 18s that fall within the means test. Covered or partially covered by private cover it’s called ‘extras’.

hearkat's avatar

It’s cosmetic, so I’d be surprised if it is routinely covered anywhere. ~10 years ago, I paid the orthodontist $200.00 a month for two years – about the length of my son’s treatment. Many now use CareCredit or similar programs to offer low- or no-interest financing.

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