The financial pain of getting braces

When it was time for Roseann Riddle's daughter to get braces, it just wasn't financially possible.

"When she was in need of braces, my husband had changed jobs and we didn't have dental insurance," Riddle said. That put the $5,000 cost of orthodontic treatment out of the family's grasp, given the cost was about 10 percent of their annual pretax income. "We've been straight up with our children to know that bills and food come first, and braces are a luxury. It broke my heart to see how that affected us."

Like Riddle's family, many Americans find themselves strapped when it comes time to get braces for their children or themselves. The average cost of braces is about $6,000, notes Melanie Johnston, the marketing director for the nonprofit Smiles Change Lives.

While that's a huge financial commitment for many families, especially given that the median U.S. household income is roughly $53,000 per year, the cost of braces has actually declined on an inflation-adjusted basis since the 1960s.

Nevertheless, when families receive an estimate from the orthodontist, the price can often be a shock. So, if the relative cost for getting braces is less than it was in the 1960s, what has changed?

One culprit: dental insurance. Back in the 1980s, most plans carried a lifetime orthodontics benefit of $1,000, according to a 1988 report published by the U.S. Bureau of Labor Statistics. Fast forward to 2014, and many orthodontic plans still offer a $1,000 lifetime coverage. That means families are on the hook for paying a greater portion of their child's braces than in earlier decades.

"I'd say 25 years ago, orthodontic coverage was about $1,000. Today, 25 years later, it's still about $1,000," noted Dr. Robert E. Varner, an orthodontist and the president of the American Association of Orthodontists. "Some plans offer $1,200, and I've very rarely seen plans at $1,500."

Of course, not every family has insurance. Varner said the number of families with orthodontic coverage has "steadily gone down over the years." It now stands at slightly more than half of American families.

At the same time, Americans increasingly want to provide their children with straight teeth, especially given what Smiles Changes Lives calls "the beauty premium," or the income bump that people with good looks receive above those with below-average looks. Increasingly, teeth are becoming a class divide, with straight, white teeth signaling middle-class comfort, while crooked teeth can convey poverty and lead to discrimination.

Riddle noted that her daughter was teased about her teeth, causing the girl to feel depressed and self-conscious about photos. "It broke my heart," she said. "It really held her back as a person."

When her daughter was in high school and mentioned she'd rather save money for braces instead of a car, Riddle said she started to search online, hoping to find a coupon to help with the cost. Instead of finding a coupon, she came across Smiles Change Lives, a nonprofit that helps families like Riddle's provide orthodontic care for their children. Riddle said her daughter, who got her braces off in April, is thriving.

A lot of families, like the Riddles, "fall through the cracks," notes Smiles Change Lives' Johnston. "They are working and getting the basics covering, but there's nothing left over."

Smiles Change Lives saw the number of applicants to its program rise each year from 2009 to 2012, marking years following the end of the recession. In 2013, applicants dropped slightly and have remained steady this year. The program, which asks families to make a $600 financial commitment to the treatment but otherwise covers the cost, is aiming to provide braces for 1,000 children this year.

Aside from nonprofits such as Smiles Change Lives, families have several options for paying for their child's orthodontic work, Varner said. Children who qualify for Medicaid are often covered, although that depends on the state.

"Almost every patient who comes into our office says, 'I can see Johnny needs braces, so how do I pay for it?'" Varner said.

First, families with orthodontic coverage can defray the overall cost by applying that benefit. Parents should also consider using flexible spending accounts, which allow workers to put aside $2,500 per year in pretax dollars to pay for health care.

Most orthodontists will let families pay for braces over 24 months, at no interest, although some offices will require a down payment as well, Varner said. Yet another option is paying through third-party financing companies, which can extend payments as long as three years or more. The downside is that such financing carries interest, but it's often less than putting the payments on a credit card.

Beyond those options and nonprofits such as Smiles Change Lives and Smiles for a Lifetime, some states provide orthodontic coverage for low-income families.

"The biggest problem are those families who fall between the cracks," Varner noted. "They make too much money to qualify for state assistance but don't make enough to afford orthodontics."