Adult metal mouth!

[missundecided]

Okay, so technically there won't be any metal in my mouth, but this question is about adult orthodontia and strategies to pay for it. Long-windedness ahead!

I received two quotes for ortho and conveniently, this is my benefit enrollment week, but I can't figure out the best way to optimize the payment towards this service. I also suspect I'm being penny wise but pound foolish.

I'm maxing out my HSA this year and plan to fund it to the max again next year. I've been slowly building it up for the past few years with occasional distributions, but it's only at about $4,000 so it's not a hefty balance. In tandem with maxing out my HSA again next year, I'm considering enrolling in a limited FSA (which only allows dental and vision expenses) to the max of $2500. That's a total of $5800, or $223 per paycheck, untaxed. (I get paid bi-weekly.)

This is how I'm visualizing that plan of action:

Quote 1:
$4500 for Invisalign, with a $2500 down payment and the rest can be paid in monthly installments. It would be a year-long treatment.

-> If I went this route, I'm considering waiting until the end of 2014 to pull from the limited FSA and then fund the 2015 limited FSA with $2000 to pay for the rest of the service. That way I can leave my HSA untouched, which is what I'd prefer. My dentist has also promised to hold this quote for me until the end of 2014. However, I worry that I shouldn't wait even longer to get this treatment done because my teeth seem to be sabotaging my mouth and now I'm all self-conscious about my bite, etc. My jaw and teeth are all I've been thinking about for the past few days!

Quote 2:
$3600 for the off-brand Clear Correction, with a $1000 down payment and the rest due in 3 installments but still pretty much upfront. It would be a 12- to 18-month treatment.

-> If I went this route, I'd pay less overall but that quote is only good for 90 days, so I may have to start my treatment at the beginning of the year and be forced to use both the limited FSA and my HSA. I asked about the 90 day thing, and the dentist's office said it is for SURE going to go up.

Either option, I'd use a rewards CC and then just pay myself back.

But I'm not sure either of these strategies is the best approach. See, I'm solidly in the 15% bracket, so I'm not entirely convinced it would be much of a tax benefit to fund a limited FSA AND do my regular HSA contributions. Secondly, I still have a small student loan left ($7600 at 5.12%) and I consistently am unable to max out my Roth, year over year. I'm also worried that the extra $100 pulled from my paycheck for the limited FSA contribution will make things even leaner for me, as I suspect my rent is going to go up, among other things, and I'm not counting on a raise next year. (However, this last concern is mostly psychological.)

My dental coverage, in case you haven't guessed, does not cover adult ortho, and in fact, in a similar vein, I am considering not carrying it anyway. My cost is only $12/period (or $312 for the year) for 90% coverage but capped at two cleanings/exams a year, and my dentist is kind enough to waive my responsibility so I haven't paid anything out of pocket. Anyway, beyond the ortho I don't foresee getting any other dental work done beyond my routine visits. (I'm going to double-check with my dentist on this anticipation.) Cleanings are about $75 with self-pay, so that's a total of $150 for the year. If I decline dental coverage, my employer will pay me $60 (woo hoo, big money! /sarcasm) spread out through the year.

So I guess in summary, my questions are:

1) Should I even bother doing a limited FSA to pay for my ortho, given my tax bracket and financial status? (I'm funding my HSA no matter what.)

• 1a)If I do do the limited FSA, is it more beneficial to go with the higher-priced treatment which can be split between two years or go with the lower-priced treatment and dip into my HSA?

2) Keep my dental coverage?

I'm probably not looking at the forest through the trees correctly, so any outside perspective would be greatly appreciated. Am I analyzing this whole situation and my options incorrectly? Am I asking the wrong questions?

And, has anyone had to get adult ortho? Had experience with either Invisalign or Clear Correction?

Thanks, and sorry for the long post!

[AlexK]

I had Invisalign in '02 (was 29 y.o.) and it worked great. Still wearing my original retainer every night and teeth are perfectly straight. I don't regret it at all.

It was painful at times and my advice is wear them as much as humanly possible because if you leave them out for a few hours it really hurts bad to put them back in.

[HappierAtHome]

No real money advice from me, but I have invisalign right now and it's wonderful. Cost me $10k (australia is expensive for orthodontia) but so, so worth it. I've had mine since the end of february and my teeth are so much straighter. It can be a little inconvenient and you can have headaches when your teeth are moving significantly, but a workmate has metal braces and there's no comparison.

That said, I waited until I could pay for it outright and did not have any debt.

[frugaldrummer]

I had old-fashioned metal braces as a teen (worked great) then had to repeat orthodontia with Invisalign in my 50's (teeth had slipped very badly out of alignment :(   ).

Invisalign was great, but to get the maximum benefit, you have to be really rigorous about wearing them almost all the time.  My treatment definitely took longer than it should have because I talk all day at work and would take them out more than I should.

I doubt there is a difference between brands - it's all done on computer, they make a mold of your teeth and then the computer designs the steps.  A good dentist may be important if your teeth are really messy like mine were - she had to file the edges of some teeth and make some tweaks to the braces in order to achieve my good results. I had severe crowding and teeth that were overlapping and twisted. But if your teeth are just a little crooked, and not too crowded, then the choice of dentist may not make that much difference.

You will definitely be happy that you did it, so I wouldn't wait.

[StarryC]

I'm a little suspicious that the "invisalign" is "so much better" than the generic version.  Can you ask the generic doctor about what the differences are, why he offers the generic, and what the disadvantages might be?  My guess is invisalign spends money on marketing to dentists and consumers, and "Clear correct" rides the wave. 

Based on your statements that you have $4,000 in our HSA, I think you do have enough money to just pay it right now, so I don't think the different payment plans should matter.

For this kind of thing, I'd advise not waiting.  1) the sooner you start the sooner it is done. 2) The sooner you start, the longer you have the benefits of straight teeth.  This isn't like a "new car" where depreciation starts immediately, or a new gadget where your enjoyment will wear off.  Hopefully you'll have your mouth for the rest of your life, and I think it's like a "new workout routine" where the benefits accre.

[Norrie]

No advice on the financial part, just a high five from another adult in braces. Mine are Incognito, which are metal braces BEHIND the teeth. Stupidest fucking thing that I've ever done. I'm 5.5 weeks in and still lisping, still eating soft food, etc.

I wanted Invisalign, but was told that they wouldn't work well for me because my bite is so off. It didn't occur to me until about a week ago that my bite has been just fine for 37 years, and that I probably didn't need to mess with it. Sigh.

[auntbecky]

I will be very interested if you would post the direction you go and your opinion after the fact.  I'm currently debating this exact thing myself.  I chose to do HSA only and wait one more year.  My scenario might be different though, as I'm not the only person on my HSA (2 adults, 3 kids) and my 12 year old is getting his round two braces in January.  I plan to get my invisalign in between my kids' sets of braces.

I feel HSA usage is very different for everyone.  I know the deductible is different for each policy and usage is different for each person.  My personal deductible is 2500 per person or 5000 family.  I've only been in it for a year now, but have used it so little so far this year that I will hit that 5000 in my HSA first thing next year.  I feel anything over that safety net is fair game for glasses, lasik, braces, etc. that don't count towards the deductible.

Also, I am very curious on others thoughts on self insuring dental and vision, like you are looking into.

[ljp555]

I've been looking at this same issue and am planning to start Invisalign in January. I'm funding both the HSA and limited FSA. My marginal tax rate is almost 45%, so the tax advantages are substantial.

Strictly by the math, looks like you should fund the FSA. Tax benefits are $2500*(15%+7.65%+(your state tax rate)), so at least $566. Interest on your student loan is less than $7600*5.12% which comes to $389, so funding the FSA is better than paying off your loan early.

However since you said you're concerned with cash flow, I would probably focus on paying off the student loan and funding the Roth. The incremental benefit to the FSA isn't worth it if you get tight on cash and have to use credit cards or cash out investments.

[Ugh]

Check Groupon and Living Social.  I have seen $2000-2800 complete Invisalign packages there if you pay it all upfront.

[StarswirlTheMustached]

Can I ask why you need the treatment?
I had a dentist recommend Invisilign to me, although I had braces years ago -- my bite was off, apparently. It was putting pressure on the teeth in all the wrong ways. They were going to crack, and explode. Hurry, hurry! Fix your teeth! Before it's too late! The cost is going up soon!

... well, ain't it strange that no dentist who didn't offer ortho ever noticed a problem? Ain't it strange that they used the exact same speech on my wife, who had perfect teeth from the womb and has never needed orthodontic treatment? Pretty sure they're advertising the same cost, too.

Caveat Emptor is all I'm saying. It's a big wad of cash to blow on being purdy.

[missundecided]

Posted by: StarswirlTheMustached
« on: Today at 05:57:31 pm »

   Can I ask why you need the treatment?
I had a dentist recommend Invisilign to me, although I had braces years ago -- my bite was off, apparently. It was putting pressure on the teeth in all the wrong ways. They were going to crack, and explode. Hurry, hurry! Fix your teeth! Before it's too late! The cost is going up soon!

... well, ain't it strange that no dentist who didn't offer ortho ever noticed a problem? Ain't it strange that they used the exact same speech on my wife, who had perfect teeth from the womb and has never needed orthodontic treatment? Pretty sure they're advertising the same cost, too.

Caveat Emptor is all I'm saying. It's a big wad of cash to blow on being purdy.

This was (is?) my line of thinking, too. If it isn't medically necessary, is it NECESSARY? And I agree, I should have seen dentists who don't offer ortho but due to my poor planning and the narrow window of time for my enrollment decisions, I ended up seeing dentists who coincidentally and oh-so-conveniently do offer these treatments. In fact, my regular dentist, who made the initial recommendation/quote, has been encouraging me to do this treatment ever since I first started seeing her several years ago but the cost of it had always intimidated me too much to explore further. However, this is what I understand: my bottom teeth are over-crowded and go every which way, making them difficult to clean. My top teeth are now descending so low that they're hitting the bottom gums and have flattened the points of my incisors, and my bottom teeth are scraping away the enamel of the backs of the top, which also are developing stress fractures. For awhile now, I have been feeling my top teeth shift, like they're getting loose, and that was before I ever had the notion of orthodontia put in my head. Still, all that said, I do admit to feeling ...not manipulated, per se, but letting myself be a mark. That could just be my cheapskate showing, though! :)

Despite my uncertainty, I'm leaning towards funding the limited FSA and if I do find my cash flow feeling tight, I think I'm okay with loosening the reigns on my HSA contributions as a last resort. I live in California, so I don't get the full tax benefit. (California doesn't grant HSAs the same tax recognition as the IRS.)

Posted by: Maigahane
« on: Today at 11:23:41 am »

As for your money options: first of all costs aren't everything, what do you think about the two orthos? I got quotes from two and one wanted to pull 4 teeth (three of them perfectly good teeth) just because 1 was a baby tooth (with no permanant) and he wanted to keep it even. The baby tooth was one the bottom and I wasn't even doing anything with those! The other guy suggested having the baby tooth pulled and an implant put in (a crown on a metal rod) and keeping my good teeth. Guess who got my money? Anyway, irrelevant story aside, just remember cheaper is not always better

Hmmm, now I'm really scratching my head and second-guessing (third-guessing?) myself. When the two dentists gave me their quotes and explanations why ortho was recommended, they didn't talk about pulling teeth (I also have a baby tooth, like you did) or implants or anything else like that. It was just, this is how long it'll take, this is how much it'll cost. I DO still have a baby tooth and when I asked about that, they didn't think it would have to come out but there wasn't any sort of specific discussion on what exactly was going to happen.

Anyway, thanks all for your various perspectives. It's given me a lot to think about, which is good but also maddening haha. In a perfect world, I'd have the leisure of time to make a decision instead of by the end of this week. Maybe I wouldn't feel so much like my arm is being twisted!

[MrsPete]

Coming at this from a completely different perspective -- kind of a cautionary tale: 

As you choose between these two orthos, is one more convenient than the other for you?  You'll be making FREQUENT trips to this office over the next 2-3 years, so this will matter.  I bring it up because my parents chose the rock-bottom priced ortho for me . . . with no consideration for the fact that he was a good hour away from home, and I couldn't drive myself.  Every month it was a headache to see who'd drive me -- often it was my grandmother.  Eventually I was able to drive my mom to work and take the car to the appointment myself, but that mean about three hours in the car total.  The cost of driving back and forth (and my mom taking an hour or so off work) ended up costing more than the difference in price between this guy and the others.  They chose more wisely for my younger siblings. 

Yes, looking back, this was a stupid choice, but that's the kind of childhood I had:  My parents would do anything to save a dollar.  Anything, that is, except bother to look at the big picture and do the real-cost math.  I saw many, many examples of penny-wise and pound-foolish as a child.   

[rocklebock]

I had a dentist recommend Invisilign to me, although I had braces years ago -- my bite was off, apparently. It was putting pressure on the teeth in all the wrong ways. They were going to crack, and explode. Hurry, hurry! Fix your teeth! Before it's too late! T

I had the exact same experience. Had braces in middle school. I'm super skeptical because it seems like if my bite were really such a disaster that my teeth were going to crack, a previous dentist would have mentioned it. I'm trying a new dentist soon, and if it comes up again, I might take it a little more seriously.

Dentists always want me to fix my diastema. They are the only people who have a problem with it. Based solely on how many dudes have told me it's sexy, I'd never get it "corrected."