Bracing Your Wallet if Your Child Needs Braces

You can see that your child’s bite is misaligned or that his teeth are sticking out in all the wrong places. You know what’s coming: months of treatment and an orthodontist bill anywhere from $3,000 to $7,000. That’s a lot of money.

“The price of braces is outrageous,” said Tina Sigman, who, interestingly, is an orthodontist’s assistant in Norton, Mass. Ms. Sigman took her 13-year-old daughter, Victoria, to the orthodontist she works for, Dr. Jeff Kane, last year to see if something could be done about the slightly protruding teeth crowding her daughter’s mouth.

“It wasn’t a major case,” Ms. Sigman said,“but it was still going to cost $3,500.”

When Ms. Sigman told Dr. Kane she couldn’t afford to pay that much, he told her aboutSmiles Change Lives, a nonprofit organization that, for a low fee, connects children whose families cannot afford braces with orthodontists willing to provide the service free. Ms. Sigman’s daughter was accepted to the program and is about halfway through treatment with Dr. Kane.

Victoria is already feeling more confident.“She was worried that her teeth stuck out,” Ms. Sigman said.“It’s a great relief to know I could do this for her.”

Getting good orthodontic care is more than just an aesthetic issue. Severe crowding or crooked teeth can inhibit good brushing and flossing, making it harder to keep teeth and gums healthy. In addition, crooked teeth or a bite that doesn’t align may strain jaw muscles and wear down teeth over time.

But paying for orthodontics can be difficult. Dentalinsurancerarely covers more than a small percentage of orthodontic treatment. Few patients find or qualify for programs like the one Ms. Sigman used.

Moreover, a push for earlier detection of problems in children may mean parents will be facing these bills much sooner than they may think. And the costs are rising with the introduction of new technologies, like three-dimensional imaging, that help with diagnosis and more precise treatments.

Smart planning and budgeting can offset some costs and make the expense easier to handle, said Dr. Lee Graber, an orthodontist in Vernon Hills, Ill., and president of the American Association of Orthodontists. These tips will help.

PROVIDERS AND FEESOrthodontists’ fees can vary widely from one area to another and from one doctor to the next. Be sure to get several recommendations from your dentist, friends and family.

Consult with at least three orthodontists to get an idea of what treatment is involved and what the price will be. Often both are negotiable, or at least up for discussion.

“We have to take the individual into account,” Dr. Kane said.“If what I think is an ideal result would make the treatment more complex and in my eyes this should be a high priority, if in the patient’s eyes it isn’t, I have to deal with that. The orthodontist has to tailor a treatment plan accordingly.”

Choose an orthodontist whom your child likes and trusts. The average treatment time is 23 months. That’s a lot of office visits, and they will be much easier if patient and doctor have a good rapport.

A PAYMENT PLANMost orthodontists offer monthly payment plans extended over the time of treatment with no interest or other charges. If you intend to use a plan, discuss the terms— how much per month over how many months— before treatment starts.

Many orthodontists are willing to extend the length of payment and make other adjustments to help ease the burden. But you need to ask.

Some orthodontists offer discounts for upfront payments. If you can afford it, this is probably the best option for an uncomplicated treatment plan. That way you won’t unwittingly pay for treatment your child ends up not needing.

Use caution with third-party extended payment programs sometimes through orthodontists’ offices. These programs extend your payments over five to seven years, but you’ll often end up paying hefty interest charges.

AFFORDABLE ALTERNATIVESIf shopping around and payment plans don’t offer enough relief, look for a college or university near you with an orthodontics program.

Much like dental schools, you can get high-quality care from residents supervised by experienced orthodontists for about two-thirds the cost of care in private practice. To find a school near you, check the list of accredited schools on theWeb siteof the American Association of Orthodontists:www.aaomembers.org/Education/Accredited-schools.cfm.

Ask your orthodontist about other programs in your area that may offer assistance. In addition to Smiles Change Lives, theSmiles for Life Foundationalso provides help to needy families, as do many state programs.

“Orthodontists are aware that access to care is an important issue,” said Dr. Kane, adding that more doctors are getting involved in pro bono programs.

INSURANCE COVERAGEIf you have dental insurance through work, check the policy or your benefits department to see what orthodontics, if any, are covered.

Most policies that offer orthodontic coverage pay only 25 percent, at most 50 percent, according to LeAnn Smith, chief operating officer of Smiles Change Lives. Still, every bit helps.

If you don’t have dental insurance, try searching for a policy atwww.dentalplans.comthat covers orthodontics. For an annual fee of $100 to $200, you’ll receive discounts at participating orthodontists.

Be sure to read the fine print. These plans can be severely limited, especially when it comes to braces. Make sure any discount adds up to more than the annual fee.

Keep in mind you can also save pretax dollars to help pay for these treatments in a flexible spending account or health savings account, if you have one.

UNEXPECTED EXPENSESKeep in mind the orthodontist’s bill may not be the only cost you incur with braces.

For adult patients particularly, getting braces may also mean a deep cleaning and the replacement of old fillings before treatment begins. For adults and children, removing teeth is sometimes part of the pretreatment plan.

In addition, clear, invisible or colored braces often cost more, but for obvious reasons can be more appealing than the less expensive traditional metal braces. Weigh the pros and cons against your budget to determine what’s best for you.

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