Orthodontic Lifetime Max Tracker
Confirm how much orthodontic insurance benefit you have left before approving new treatment phases. Enter the plan's lifetime orthodontic maximum and what the carrier has already paid. Optionally add pending claims so you see the true remaining cushion once they adjudicate. The summary highlights remaining coverage, utilization percentage, and total insurer spend if all claims clear.
Calculations assume insurer payment data is accurate. Verify outstanding balances and coordination of benefits with your dental carrier.
Examples
- $3,000 lifetime max, $1,850 paid, $400 pending ⇒ Remaining coverage: $750.00 • Lifetime max used: 75.0% • Insurer exposure if pending claims pay: $2,250.00
- $2,500 lifetime max, $900 paid, no pending claims ⇒ Remaining coverage: $1,600.00 • Lifetime max used: 36.0% • Insurer exposure if pending claims pay: $900.00
FAQ
Does the lifetime max reset each year?
No. Orthodontic lifetime maximums are cumulative. They do not reset with the calendar year the way preventive and basic dental benefits often do.
How do flexible spending accounts interact with orthodontic benefits?
FSAs can reimburse your out-of-pocket share even after insurance hits the lifetime cap. Use the remaining coverage output to plan FSA elections for future years.
What if multiple children share the same cap?
Some plans have a per-family orthodontic cap. If so, treat the lifetime maximum as the family limit and include claims paid for each child to monitor the shared balance.
Additional Information
- Many dental plans apply a single orthodontic lifetime maximum per member, regardless of the number of treatment episodes.
- Pending claims are treated as fully approved to give a conservative remaining balance; if they are denied, re-run the numbers.
- Once the lifetime maximum is exhausted, you are responsible for 100% of additional orthodontic charges.