The Cost Of Braces Using Fedvip?
If you are a federal employee, a retiree, or a family member of one, you have access to one of the best dental insurance programs in the country: FEDVIP. The Federal Employees Dental and Vision Insurance Program offers comprehensive coverage, including orthodontic treatment. But how much do braces actually cost when you use FEDVIP?
The answer depends on the plan you choose, the type of braces you need, and the orthodontist you visit. On average, FEDVIP covers 50% of the cost of braces after you meet your deductible. With a lifetime maximum of $3,500 to $5,000, most patients pay between $1,500 and $3,500 out of pocket for a full treatment.
This guide will break down everything you need to know about using FEDVIP for braces. We will explain what FEDVIP is, how it works, and which plans offer the best orthodontic coverage. We will compare the major FEDVIP dental carriers. We will walk you through the process of finding an in-network orthodontist, getting pre-authorization, and maximizing your benefits. By the end, you will have a clear picture of what to expect.
What Is FEDVIP?
FEDVIP stands for the Federal Employees Dental and Vision Insurance Program. It is administered by the U.S. Office of Personnel Management (OPM). FEDVIP provides dental and vision insurance to:
- Federal employees.
- Federal retirees.
- Active duty and retired military members (as of 2018).
- Certain family members.
FEDVIP is not the same as the Federal Employees Health Benefits (FEHB) program. FEHB is for medical insurance. FEDVIP is specifically for dental and vision. You can enroll in FEDVIP even if you are not enrolled in FEHB.
Does FEDVIP Cover Braces?
Yes. Most FEDVIP dental plans cover orthodontic treatment for both children and adults. This is a significant benefit. Many private dental insurance plans only cover braces for children under 18. FEDVIP plans typically cover adults as well.
Coverage details vary by plan. Some plans have different waiting periods, lifetime maximums, and coverage percentages. We will explore these differences in detail.
How FEDVIP Orthodontic Coverage Works
Understanding how FEDVIP covers braces is essential for budgeting. Here are the key components.
1. Annual Deductible
You must meet an annual deductible before your insurance starts paying. The deductible for FEDVIP dental plans ranges from $0 to $150 per person per year. Some plans waive the deductible for preventive services, but orthodontics usually requires the deductible to be met first.
2. Coverage Percentage
After you meet your deductible, FEDVIP pays a percentage of the cost. Most plans cover 50% of orthodontic treatment. Some plans cover more, up to 60% or 70%. You are responsible for the remaining percentage.
3. Lifetime Maximum
FEDVIP plans have a lifetime maximum for orthodontic coverage. This is the most the plan will pay for orthodontics over your lifetime. Lifetime maximums range from $2,500 to $5,000. Once you reach this maximum, you pay the full cost of any further orthodontic treatment.
4. Waiting Periods
Some FEDVIP plans have a waiting period before orthodontic coverage begins. This can be 6 to 12 months. If you enroll and need braces immediately, you may have to wait before your coverage kicks in. Other plans have no waiting period.
5. Pre-Authorization
Most FEDVIP plans require pre-authorization for orthodontic treatment. You must submit a treatment plan from your orthodontist to the insurance company before treatment begins. The insurance company will review the plan and confirm how much they will pay.
6. Dependent Coverage
FEDVIP plans cover dependents, including children and spouses. Each family member has their own lifetime maximum. This means if you have two children who need braces, each child has their own $3,500 lifetime maximum.
Comparison Table: How FEDVIP Orthodontic Coverage Works
| Feature | Typical Range |
|---|---|
| Annual Deductible | $0 – $150 |
| Coverage Percentage | 50% – 70% |
| Lifetime Maximum | $2,500 – $5,000 |
| Waiting Period | 0 – 12 months |
| Pre-Authorization | Usually required |
| Adult Coverage | Usually included |
| Dependent Coverage | Yes, each has own maximum |
The Average Cost Of Braces With FEDVIP
Let’s look at a real-world example. Suppose your orthodontist charges $5,000 for a full braces treatment. Here is how the costs break down with a typical FEDVIP plan.
| Cost Component | Amount |
|---|---|
| Total Orthodontic Fee | $5,000 |
| Annual Deductible | $100 |
| Amount Subject To Coverage | $4,900 |
| Insurance Pays (50%) | $2,450 |
| Your Out-of-Pocket Cost | $2,550 |
| Lifetime Maximum Remaining | $1,050 (if max is $3,500) |
In this example, you pay $2,550 out of pocket. The insurance pays $2,450. Your remaining lifetime maximum is $1,050. This could be used for retainers or future orthodontic needs.
If you have a plan with a higher lifetime maximum of $5,000, the insurance would pay $2,450, and your out-of-pocket would still be $2,550. The difference is that you would have more lifetime maximum remaining.
Major FEDVIP Dental Carriers And Their Orthodontic Coverage
FEDVIP offers several dental plans. Each has different premiums, deductibles, coverage percentages, and lifetime maximums. Here is a comparison of the major carriers.
| Carrier | Plan Name | Coverage % | Lifetime Max | Waiting Period | Adult Coverage |
|---|---|---|---|---|---|
| Aetna | Aetna Dental | 50% | $3,500 | None | Yes |
| Blue Cross Blue Shield | FEP BlueDental | 50% | $3,500 | None | Yes |
| Cigna | Cigna Dental | 50% | $3,000 | None | Yes |
| Delta Dental | Delta Dental | 50% | $3,500 | None | Yes |
| GEHA | GEHA Dental | 50% | $3,500 | None | Yes |
| Humana | Humana Dental | 50% | $3,000 | None | Yes |
| MetLife | MetLife Dental | 50% | $3,500 | None | Yes |
| United Concordia | United Concordia | 50% | $3,500 | None | Yes |
Note: Coverage percentages and lifetime maximums can change annually. Always check the current plan brochure for the most up-to-date information.
Which FEDVIP Plan Is Best For Braces?
The best plan for you depends on your specific needs. Here are some factors to consider.
1. Lifetime Maximum
A higher lifetime maximum means more coverage for expensive treatments. Plans with $3,500 or $5,000 maximums are better than those with $2,500.
2. Waiting Period
If you need braces soon, choose a plan with no waiting period. Some plans require you to be enrolled for 6 to 12 months before orthodontic coverage begins.
3. Premiums
Higher premiums often mean better coverage. But you need to balance the monthly cost with the benefits. If you are planning to get braces, a plan with a higher premium but better orthodontic coverage might save you money in the long run.
4. Network
Check if your preferred orthodontist is in the plan’s network. If not, you may have to pay more out of pocket.
5. Coverage For Adults
Most FEDVIP plans cover adults, but some may have limitations. Check the plan details carefully.
6. Additional Benefits
Some plans offer extra benefits like coverage for retainers, accidental injury, or a higher percentage for in-network providers.
How To Enroll In FEDVIP
Enrolling in FEDVIP is done through the OPM website during the annual Open Season. Open Season typically runs from mid-November to mid-December. You can also enroll or change plans if you experience a Qualifying Life Event (QLE), such as marriage, birth, or a change in employment.
Step 1: Visit The OPM Website
Go to the OPM FEDVIP page. You will find plan brochures and comparison tools.
Step 2: Compare Plans
Use the comparison tool to compare premiums, deductibles, coverage, and networks.
Step 3: Choose A Plan
Select the plan that best fits your needs.
Step 4: Enroll
You can enroll online through the OPM website or by calling the FEDVIP enrollment center.
Step 5: Confirm Enrollment
You will receive a confirmation and your insurance card. Coverage begins on January 1st of the following year.
How To Find An In-Network Orthodontist
Using an in-network orthodontist is essential for maximizing your FEDVIP benefits. In-network providers have agreed to accept the insurance company’s negotiated rates. This means you pay less out of pocket.
1. Use The Insurance Company’s Website
Every FEDVIP carrier has an online provider directory. Enter your zip code and search for orthodontists.
2. Call Your Insurance Company
Call the customer service number on your insurance card. They can help you find in-network orthodontists in your area.
3. Ask Your Dentist
Your general dentist may know which orthodontists in your area accept FEDVIP.
4. Ask The Orthodontist’s Office
When you call to schedule a consultation, ask if they accept your FEDVIP plan. Ask if they are in-network.
What If You Want To See An Out-Of-Network Orthodontist?
You can see an out-of-network orthodontist, but you will pay more. The insurance company will reimburse you based on their out-of-network rates, which are usually lower than in-network rates. You may also have to pay the full amount upfront and submit a claim for reimbursement.
The Process Of Getting Braces With FEDVIP
Here is a step-by-step guide to getting braces with FEDVIP.
Step 1: Consultation
Visit an in-network orthodontist for a consultation. They will examine your teeth and take X-rays.
Step 2: Treatment Plan
The orthodontist will create a treatment plan and give you a quote for the total cost.
Step 3: Pre-Authorization
Submit the treatment plan to your FEDVIP insurance company for pre-authorization. The insurance company will review it and confirm how much they will pay.
Step 4: Approval
Once the pre-authorization is approved, you can start treatment. The orthodontist will bill the insurance company directly.
Step 5: Payment Plan
You will set up a payment plan with the orthodontist for your portion of the cost. This is usually a down payment plus monthly payments.
Step 6: Treatment
The braces are placed, and you visit for adjustments. The insurance company pays its portion, and you pay yours.
Step 7: Retention
After braces are removed, you get retainers. Check if your plan covers retainers. Some do, some do not.
What About Retainers?
Retainers are essential after braces. Some FEDVIP plans cover retainers as part of the orthodontic benefit. Others charge separately. Retainers typically cost $200 to $600. If your plan covers them, the cost is applied to your lifetime maximum. If not, you pay out of pocket.
Quotes From Federal Employees Who Used FEDVIP For Braces
“I used GEHA for my daughter’s braces. The total cost was $5,500. GEHA covered $2,750. We paid $2,750 out of pocket. The payment plan was $150 a month for 18 months. It was very manageable.” — Jennifer, Virginia
“I have Delta Dental through FEDVIP. I got Invisalign for myself. The cost was $6,000. Delta covered $3,000. I paid $3,000 out of pocket. I used my FSA to cover most of it.” — Mike, Maryland
“I compared all the FEDVIP plans before Open Season. I chose MetLife because they had the highest lifetime maximum. It was the best choice for my family.” — Sarah, California
How To Maximize Your FEDVIP Orthodontic Benefits
Here are some tips to get the most out of your FEDVIP coverage.
1. Choose The Right Plan During Open Season
If you know you will need braces, choose a plan with a high lifetime maximum and no waiting period. Compare plans carefully.
2. Use In-Network Providers
In-network orthodontists have negotiated rates. This saves you money.
3. Get Pre-Authorization
Always get pre-authorization before starting treatment. This ensures the insurance company will pay their portion.
4. Use Your FSA Or HSA
You can use pre-tax dollars from your Flexible Spending Account (FSA) or Health Savings Account (HSA) to pay for braces. This saves you 20% to 30%.
5. Plan For The Lifetime Maximum
If you have multiple family members who need braces, remember that each person has their own lifetime maximum. You can stagger treatment to manage costs.
6. Ask About Discounts
Some orthodontists offer discounts for paying in full or for multiple family members. Ask.
7. Check For Retainer Coverage
Ask your insurance company if retainers are covered. If not, budget for them separately.
Comparison Table: FEDVIP Vs. Private Dental Insurance For Braces
| Feature | FEDVIP | Typical Private Insurance |
|---|---|---|
| Adult Coverage | Usually yes | Often limited |
| Lifetime Maximum | $2,500 – $5,000 | $1,000 – $2,000 |
| Coverage Percentage | 50% – 70% | 50% |
| Waiting Period | Often none | Often 6-12 months |
| Pre-Authorization | Required | Required |
| Premium Cost | Varies | Varies |
FEDVIP generally offers better orthodontic coverage than private insurance, especially for adults.
Important Note For Readers
FEDVIP plan details, premiums, and coverage change every year. The information in this article is based on current plan designs but may not reflect the most recent updates. Always check the official OPM FEDVIP website or your plan brochure for the most up-to-date information. This article is for informational purposes only and does not constitute insurance advice.
Frequently Asked Questions (FAQ)
1. Does FEDVIP cover braces?
Yes. Most FEDVIP dental plans cover orthodontic treatment for children and adults. Coverage is typically 50% after a deductible.
2. How much do braces cost with FEDVIP?
With FEDVIP, you typically pay 50% of the cost after your deductible. Most people pay $1,500 to $3,500 out of pocket for a full treatment.
3. What is the lifetime maximum for FEDVIP orthodontics?
Lifetime maximums range from $2,500 to $5,000, depending on the plan.
4. Is there a waiting period for FEDVIP orthodontics?
Some plans have a waiting period of 6 to 12 months. Others have no waiting period. Check your plan details.
5. Can I get braces as an adult with FEDVIP?
Yes. Most FEDVIP plans cover adults. This is a significant advantage over many private insurance plans.
6. Do I need pre-authorization for braces with FEDVIP?
Yes. Most plans require pre-authorization before orthodontic treatment begins.
7. Are retainers covered by FEDVIP?
Some plans cover retainers. Others do not. Check your plan details.
8. Can I use an out-of-network orthodontist with FEDVIP?
Yes, but you will pay more. In-network providers have negotiated rates that save you money.
9. How do I enroll in FEDVIP?
You can enroll during Open Season (mid-November to mid-December) or if you have a Qualifying Life Event. Enrollment is done through the OPM website.
10. Which FEDVIP plan is best for braces?
The best plan depends on your needs. Look for a plan with a high lifetime maximum, no waiting period, and coverage for adults. Compare plans during Open Season.
Conclusion
Using FEDVIP for braces can save you thousands of dollars. Most plans cover 50% of the cost after a deductible, with lifetime maximums of $2,500 to $5,000. Adult coverage is a major benefit. By choosing the right plan during Open Season, using in-network providers, and getting pre-authorization, you can maximize your benefits and minimize your out-of-pocket costs. Braces are an investment in your smile and your health. With FEDVIP, that investment is more affordable.
Additional Resource:
For more information on FEDVIP and to compare plans, visit the official U.S. Office of Personnel Management website:
