Ortho Coverage: Primary and Secondary

by IFadmin

Orthodontic Coverage: Primary and Secondary Help Needed!

Hi everyone!

My child is getting braces, which will total $5,000. The coverage details are as follows: Mom’s plan covers 60% up to $2,000, and Dad’s plan covers 50% up to $1,500.

With this in mind, does that mean our total out-of-pocket expense will amount to $1,500?

Thanks for your insights!

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One thought on “Ortho Coverage: Primary and Secondary”

  1. Hi!

    To calculate the total out-of-pocket cost for the braces, we need to apply the coverage from both parents.

    1. Mom’s Coverage:
    2. Her plan covers 60% of the cost, but only up to $2,000.

    3. 60% of $5,000 is $3,000, but since that exceeds her limit, she will pay $2,000.

    4. Dad’s Coverage:

    5. His plan covers 50% of the cost, but only up to $1,500.
    6. 50% of $5,000 is $2,500, but again, that exceeds his limit, so he will pay $1,500.

    Now, let’s add up what the parents will pay:
    – Mom pays: $2,000
    – Dad pays: $1,500
    – Total coverage from both: $2,000 + $1,500 = $3,500

    Since the total cost of braces is $5,000:
    – Total out-of-pocket cost = Total cost – Total insurance coverage
    – Total out-of-pocket cost = $5,000 – $3,500 = $1,500

    So yes, the total out-of-pocket cost will be $1,500.

    I hope this helps! Let me know if you have any other questions.

    Reply

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