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Using a HSA or FSA to Pay for Braces

May 21st, 2020

We know that even though we offer arguably the best value for orthodontic treatment in all of metro Denver, orthodontic care can still be very expensive for most families.  While you want great care for you and/or your child, and so you likely are not just looking for the cheapest provider (as I often note, if you needed open-heart surgery, you wouldn’t look for the cheapest surgeon, but rather a great one that may also be affordable—and we would hope this is the same mindset when looking for an orthodontist in Denver), you still would like to find a place you can afford. With these concerns in mind, we are often asked about financial issues and if we know of any ways to make braces more affordable. To that end, we thought it would be great to discuss the advantages of HSAs and FSAs and how they can save you a significant amount of money when paying for braces.

To understand FSAs and HSAs, we need to begin with a bit of finance 101.  What is an HSA, what is an FSA and how are they different? At a high level, both HSAs and FSAs are ways that the IRS has set up for you to save money on medical expenses. They are similar, but different important ways. So we will now describe each.

Let’s start with FSA. FSA stands for Flexible Savings Account. It is typically offered by large employers and is something that you would ask to have set up during open enrollment for the following year.  The way it works is that you have your employer set aside a certain portion of your paycheck BEFORE ANY TAXES ARE APPLIED to be used for medical expenses. You may then use this money for medical expenses without these funds ever being taxed.  Let’s look at an example. Let’s say you get $1000 of gross pay on your paycheck and you pay 30% in taxes. Normally you’d get a check for $700 after taxes.  Now let’s say you put $100 of what you earned into your FSA account. Your paycheck would now be $900 less $270 in taxes, so $630.  But you also have the $100 you can spend to pay medical bills (typically your employer will provide you with a credit card tied to your FSA account).  As a result, in this example, you end up with $730, or $30 more than if you did not have an FSA. And the FSA funds, as long as they are used for medical expenses, are NEVER taxed. To use these funds, you do need to present evidence to the FSA administrators that the funds were actually used to pay for a medical expense.  In most cases, a simple receipt from the doctor or store (there is a lot of flexibility in what is considered a medical expense, so often things like eyeglasses, over-the-counter medicines, and even things like massages may be acceptable depending on the rules of the plan provided) will suffice. Is there a downside or risk of using an FSA?  Yes. The IRS rules say that if you do not use your FSA funds for the year, whatever balance is remaining gets forfeited to the IRS. Typically (those this does vary by FSA plan) there is a grace period of a couple of months beyond the New Year to spend these funds, but it is important that you plan and monitor this account. The net-net is that FSAs are a great way to save a significant amount in taxes if you have a known medical expense for the coming year (like paying for braces!) but is not something that most advisors would recommend doing if you do not know if you will have any medical expenses of any significance in the year to come. For 2020, employees can contribute up to $2,750 to health FSAs (and yes, spouses can BOTH do this).

An HSA (which stands for Health Savings Account) is similar to an FSA in that it can help pay for medical expenses tax-free, but is different in some key important ways.  Unlike an FSA, you do not need your employer to offer an HSA. Setting up an HSA has two key components.  First, you need to select and HAS-eligible insurance plan.  This will be a high-deductible plan, but the tax savings from the HAS will almost certainly outweigh the added deductible expense you incur. Once you have an HSA eligible plan, you would open up an HSA account. This typically can be done at your local bank. You would then contribute to this account.  While you are obviously funding the account with after-tax money, when you file your taxes the following year you will be able to deduct whatever amount you contributed to your HAS from your taxable income. This will either reduce the amount of taxes you owe or increase your tax refund.  The tax benefit is based on the money you contribute, not on the money you use from this account. One key difference from an FSA is that the IRS will not take this money from you if you don’t use it.  In fact, it can accumulate year-over-year.  Every year, the amount you put in is the amount you will be able to deduct from your taxes when you file. The new HSA limits for 2020 are $3,550 for individuals and $7,100 for families.

Can you have both an FSA and an HSA? Generally speaking, FSAs and HSAs cannot be used at the same time, although a limited-purpose, or "HSA-compatible" FSA, will allow individuals to also receive benefits from an HSA. A limited-purpose FSA is a healthcare spending account that can only be used for eligible vision and dental (and orthodontic!) expenses. So, as it relates to paying for braces, if your employer offers a limited purpose FSA, you can indeed use both.

Another nice element in using these tax-saving tools for paying for braces is that our services are spread out over time.  This offers two main advantages.  First, depending on when during the year you start treatment, you can spread your payments across 2 or even 3 separate years and as such use FSA or HSA funds to pay for the entire cost of treatment—yielding you as much as $1500-$2000 in tax savings.  Additionally, as our services are spread over time, we can, quite legally, adjust the timing of our payment arrangements to better optimize the use of your FSA and HSA accounts. HSA and FSA

We hope that by understanding these tax-saving features it will make it far more affordable to help you and/or your child get the smile of your/their dreams! As always, if you are here in the metro Denver area, we’d LOVE to see you! We openly take nearly ALL insurances, have been named a 5280 Top Orthodontist for the past 10 years, and winner of the #1 practice in the state by Colorado Parent. As noted, we are confident we offer the absolute best value in orthodontics in Colorado, with world-class care at affordable fees. While still a family-owned and operated practice, have 9 locations throughout the city to see patients. Just give one of our offices a call and schedule for a consultation.

We hope this all helps!

Will Insurance Help Pay For Braces?

May 21st, 2020

Private insurance can be a very complicated issue, especially as it relates to orthodontic care. In this blog, we’ll try to break it down so that you can best know what your insurance may or may not cover and what to ask when choosing your dental plan at your next open enrollment.

Orthodontics Insurance

First, a bit of a disclaimer that is important to understand when discussing dental insurance. EVERY PLAN IS DIFFERENT.  Even as we discuss generalities of plans below, understand there can and always will be exceptions.  We have seen some crazy stipulations in specific plans and at least once a month, having seen thousands of plans, we still find something that surprises us.  Why are these plans all so different?  Well, put simply, the insurance companies put forth a very wide range of options for your employer to chose from when selecting and forming a plan.  Each of these options has pros and cons.  Some will cost your company more money, but give you better coverage.  Others may save them money, but place greater rules or restrictions on your coverage. Your employer creates the plans with the insurance company in a manner that best represents their desired balance between the coverage they’d like you to have and how much they are will to spend to provide it.

So, do all dental insurance plans cover orthodontics?  No. Some plans do not have any orthodontics benefits.  So while they may help pay to get your teeth cleaned, or a filling at the dentist, they will not cover any of the costs for braces, Invisalign, aligners, or any other type of orthodontic treatment. Other plans that DO have orthodontic benefits may have age limits on these benefits.  For example they may cover your dependants up to a certain age (often this will be something like 19 or 25) but not cover you or your spouse. Additionally, if you get the coverage after braces are already on your (or your child’s) teeth, some plans will cover work in progress while others will not. These are all questions to ask your HR representative before signing up for a plan.

Why don’t all orthodontists and dentists accept every plan? The issue often has to do with contracted fee schedules.  When a doctor agrees to accept specific insurance, they are also agreeing to only charge patients a specific amount dictated by the insurance company. A well known dental plan in this state, for example, has a standard contract across all providers that mandates that their insureds be charged no more than $5,205 for comprehensive orthodontic care or Invisalign.  So, if you are an orthodontist who typically charges $8,000 for these services, you may choose not to join this network as it would force you to take a deep discount on your services.  Alternatively, if you are a doctor that might normally charge $5,300 for these services (or less), you may be excited to join this network as you would be willing to accept the slight discount in return for the increased number of patients who would likely come to see you because you accept their insurance. These negotiated fee schedules can come more into play when it comes to certain discount plans and DHMOs which we will now explain.

Let’s now discuss the two main types of insurance plans: PPOs (Preferred Provider Organizations) and DHMOs (Dental Health Maintenance Organizations). 

  • Typically, PPOs, if they have orthodontic benefits on the plan, will provide specific lifetime coverage for each of the insureds on the plan. These benefits will also have a percentage limit that the plan will plan for the total charges. This is best explained through a few examples. Let’s say (and this is the most typical coverage we see) that your plan provides $1,500 in orthodontic benefits paid at 50%.  If the negotiated fee for braces is $5,200, the plan would pay $1,500 as long as you have the same insurance throughout the complete time of treatment. If, however, the care you are receiving was limited and so you were only charged $2,800, the plan would only pay $1,400 as this would hit the 50% limit set by the plan. Another example, if your child needed early, phase 1 care and you will billed $2,000 for this treatment, the plan would pay $1,000 of the $1,500 benefit.  If years later you still had the same plan and your child needed phase 2 (comprehensive) care, the plan would only pay the remaining $500 of coverage as the plan’s benefits were stipulated as lifetime benefits.  In any of these cases, as is with nearly all dental insurance, the benefits are paid out to the provider over the course of treatment.  So if you lose coverage at any time during care, some of the charges  you may have expected to be covered by insurance will be shifted back onto your account (you can, of course, provide a new insurance and, if it covers work in progress, it can be billed instead).
  • DHMOs can work much like a PPO, or they can work with co-pays associated with each procedure.  If there are co-pays, the provider must calculate your coverage by assessing the difference between the co-pay and the contracted rates for each procedure. Often the number of months your care requires will also drive your coverage as DHMO benefits often involve a monthly care component to this calculation. Again, like a PPO, payments are made over time, so if you lose coverage, you may see charges shifted back to your account.  One of the key benefits, and limitations of a DHMO to you, the insured, have to do with their contracted rates.  Typically, most DMHOs offer greatly reduced contracted fee schedules relative to PPOs.  While this is great for you in you can find an in-network provider that is of high quality (as it forces them to charge you a far lower fee for the service), the issue is that it greatly reduces the number of high-quality providers who are willing to work for these greatly reduced fees.  So yes, you can save a lot of money, but you may have a hard time finding a good and highly reputable doctor who accepts your insurance (they do exist, however—our practice is proof positive of this!). Often there is also the trade-off that while the contracted rates are far more aggressive, the amount paid by the insurance company is often less than the typical PPO plan, so your net out of pocket expense may still be similar.  But again, this can vary greatly and there are exceptions to every point noted here.

Separate from PPOs and DHMOs, there are discount plans.  These plans, if accepted by your provider, will provide you greatly reduced contracted fees, but will not provide any additional benefits beyond these discounted prices.

What if mom and dad both have a child covered under their separate plans? In most cases, the good news is you CAN double-dip and receive benefits from both plans. The way this is calculated become very complex and varies a lot by the plan, but often is based on which plan is considered primary and which secondary.  Believe it or not, the industry has generally used a rule-based on where on the calendar each parent’s birthday falls, with the parent having the earlier birthday considered as having the primary insurance.

So, is private dental insurance complicated? Yes, absolutely! Hopefully, this blog has helped shed a bit more light on dental insurance and how it works. You should also appreciate that the insurance team at your orthodontist’s and dentist’s office are working hard to help you get these benefits. We know we’ll get the same money, in the end, either way, but also appreciate that we have far happier patients that are willing to come back and refer their friends if we can help them get every penny for insurance that is possible. You should appreciate that if you are not getting the coverage you had hoped for or expected, that this is not typically the fault of your doctor’s team, but rather they are on your side to work and communicate with the insurance companies to help you try to receive greater coverage if at all possible.

Lastly, if you are here in the metro Denver area, we’d LOVE to see you! We openly take nearly ALL insurances (and to our knowledge are the only 5280 Top Orthodontist (and have been for 10 years!) and winner of the #1 practice in the state by Colorado Parent magazine that does so), and, while still a family-owned and operated practice, have 9 locations throughout the city to see patients. Just give one of our offices a call and schedule for a consultation.

We hope this all helps!

Meet the Doctors at Colorado Orthodontics

May 21st, 2020

Colorado Orthodontists serve four locations in the Colorado area. All of our doctors are trained specialists in multiple top programs and fields. Read on to meet the doctors.

Dr. Hilary Nieberg Baskin

For more than 20 years, Dr. Baskin has been fulfilling her dental calling. She strives to help patients of all ages with every orthodontic need. With an impressive roster of education and experience, Dr. Baskin brings a unique perspective to her work. 

Education

  • Undergraduate degree completed at Colorado College
  • Dental School Education acquired at University of Nebraska
  • General Practice Residency completed at the Denver VA Medical Center
  • Orthodontic Certificate obtained at Yeshiva University’s Albert Einstein College of Medicine and New York’s Montefiore Medical Center

Experience

Dr. Baskin has completed impressive orthodontic x-ray analysis research. After publication, this research was honored with a Davidson Award - a nomination commonly given to a dental graduate student who exemplifies proficiency and thoroughness in clinical proceedings, as well as concern for the welfare of patients. She founded All About Braces in 2007. 

Memberships

Dr. Baskin stays up-to-date on all orthodontics news and advances because of her numerous memberships to professional orthodontics organizations. These include:

  • The American Dental Association
  • The American Association of Orthodontists
  • The World Federation of Orthodontists
  • The Colorado Dental Association
  • The Metropolitan Denver Dental Society
  • The Rocky Mountain Society of Orthodontists

Dr. David Mershon

A Colorado native, Dr. Mershon has both the education and experience that makes him a premier local orthodontist. He prides himself on fixing any issue you may have and is extremely passionate about his work in the dental field. 

Education

  • Undergraduate Degree in Biology with a Chemistry Minor from Loyola University
  • Doctorate in Dental Surgery and Sciences from Marquette University’s School of Dentistry
  • Completion of Orthodontic Program from Marquette University

Experience

Dr. Mershon has spoken in many lectures to students of all ages in both public schools and private universities. He excels at treating patients with disabilities and sensory issues and has expertise in the fabrication of crowns, bridges, dentures, and implants. 

Memberships

Dr. Mershon’s participation in various professional organizations allows him to stay current in the world of orthodontics. His many memberships include:

  • The American Dental Association
  • The American Association of Orthodontists
  • The World Federation of Orthodontists
  • The Colorado Dental Association
  • The Metropolitan Denver Dental Society
  • The Rocky Mountain Society of Orthodontists

Dr. Krystal Baumgartner

 

Originally from North Dakota, Dr. Baumgartner is now passionate about helping Denver residents with all their orthodontic needs. She is a recent graduate and likes to stay up-to-date on new orthodontist advancements. When she’s not in the office, you can find her enjoying great Colorado outdoors.

 

Education

  • Undergraduate Degree from the University of North Dakota in Grand Forks
  • Doctorate of Dental Surgery from the University of Colorado School of Dental Medicine
  • Completed Orthodontic Residency Certificate and Master of Science at Saint Louis University

Experience

Dr. Baumgartner has extensive training in many state-of-the-art orthodontist techniques. These include:

  • Soft-tissue lasers
  • Mini-screw implants
  • Cone-beam CT
  • Indirect bonding techniques
  • Invisalign®

Because of her extensive training, education, and study, she has been featured in national publications that represent the American Association of Orthodontists

 

Memberships

  • The American Association of Orthodontists
  • The American Dental Association
  • The Colorado Dental Association
  • The Metropolitan Denver Dental Society 

Dr. Shane Hoelz

 

A Wisconsin native, Dr. Hoelz has practiced in New York City and Colorado. During his time at the University of Wisconsin-Green Bay, he was a member of the Nordic Ski Team and became an Academic All-American athlete. When he’s not in the office, you can find him hitting the slopes.

 

Education

  • Undergraduate Degree in Chemistry and Human Biology from University of Wisconsin-Green Bay, graduated summa cum laude
  • Doctorate of Dental Surgery from Buffalo School of Dental Medicine
  • Postgraduate Certificate in Orthodontics from Rutgers University 

Experience

Dr. Hoelz has proven his excellence in his field by becoming a Diplomate of the American Board of Orthodontics. 

 

Memberships

  • The American Association of Orthodontics
  • The Rocky Mountain Society of Orthodontists

 

Dr. James Bloom

 

After practicing in Florida and New York for years, Dr. Bloom now resides in Denver. His family is very important to him, and so are his patients. He enjoys exploring more of Colorado when he is not working.

 

Education

  • Bachelor of Science in Biophysics from Brigham Young University 
  • Doctorate of Dental Surgery from the University of Maryland 
  • National Health Service Corps Scholarship from the U.S. Department of Health and Human Services

Experience

Dr. Bloom has completed special training at Maimonides Medical Center and is skilled in many areas of expertise. He received an award from the American Association of Orthodontists for his 3D-printing orthodontist research. 

 

Dr. Theresa Shaver

 

Dr. Shaver is an orthodontist dedicated to making her patients smile. A practicing Denver orthodontist since 1995, she has extensive expertise in helping patients with any need. When she’s not at the office, she loves enjoying the Colorado outdoors with her dog and children. 

 

Experience

Dr. Shaver works with many organizations, helping to sponsor everything from local events to fundraisers. She is passionate about her work in the Denver community. Additionally, she works with the non-profit Colorado Orthodontic Foundation to bring low-cost dental care to children. 

Welcome to Our Blog

May 20th, 2020

Thank you for taking the time to visit our blog. Please check back often for weekly updates on fun and exciting events happening at our office, important and interesting information about orthodontics and the dental industry, and the latest news about our practice.

Feel free to leave a comment or question for our doctors and staff - we hope this will be a valuable resource for our patients, their families, and friends!

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