You’ve likely been to plenty of routine cleanings, and you may have even had a few fillings or a root canal. And if you have dental insurance, you might not have had to pay for much of it. But orthodontic treatment is different. Your insurance plan might provide orthodontic benefits, or it might not. Before jumping into teeth-straightening treatment, study your plan’s details so you know what to expect from your treatment bill.
If you have Aetna, there’s a chance that your clear aligner or braces treatment will be covered, but this will depend upon your particular plan, your misalignment, and the form of treatment you select. Read through this guide for an in-depth look at Aetna’s coverage and instructions on how you can use it.
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Average Costs Before Insurance
You may have heard that orthodontic treatment is expensive, and it is. But your specific cost depends on your condition, your dentist or orthodontist, your location, and the type of treatment you choose.
Invisalign is one of the most popular orthodontic treatments amongst adults — but it’s also one of the most expensive. On average, treatment costs somewhere in the range of $3,000-$8,000, though your bill may fall somewhere outside these numbers. Many factors play into the cost of treatment, including the complexity of your case and how many Invisalign patients your doctor has treated. Read through our true cost of Invisalign guide for a closer look.
Other In-Office Aligners
Invisalign took clear aligners mainstream but you have many more options. If you’re looking to cut costs, ClearCorrect and SureSmile are two companies that tend to offer more affordable treatment. ClearCorrect prices usually fall into the $3,000–$5,000 range, while SureSmile is usually between $2,000 and $6,000. 3M Clarity is another Invisalign competitor to consider. While not more affordable, it has a wider scope of treatment.
At-Home Clear Aligners
If price is your biggest motivator, you might want to consider at-home clear aligners. These are administered remotely — no office visits required. This means all the usual office visits and doctor’s fees are taken out of the equation. On average, these cost $1,200–$2,500, which is typically thousands less than traditional options.
Byte is our top-choice at-home clear aligner provider, and while they don’t have the lowest price point, they offer a lot of value. Treatment plans average just 4–5 months and they include a lot of great items in their bundle. They also back their results with a lifetime guarantee. They charge a flat rate — $1,999 for all-day treatment and $2,399 for night-only aligners — and they handle the insurance claims process from start to finish. Check out our guide on insurance coverage with Byte for more info.
Braces are the classic option for straightening teeth — but they can also be the most expensive. Standard braces usually cost around $4,000–$6,000, but options like self-ligating and lingual braces can cost more than $10,000. See our guide on the true cost of braces for more information.
What Does Dental Insurance Usually Cover?
Dental coverage is complicated. Terms vary not just between providers, but between policies issued by the same company. Companies tend to classify procedures as preventative, basic, major, or cosmetic and then establish coverage levels for each category — potentially excluding some categories altogether.
Dental plans are most open to covering preventative treatments, often offering 100% coverage for things like routine cleanings. This is a logical choice for a company looking to make a profit; they pay for the most affordable treatments to prevent policyholders from needing more expensive care later on. Basic treatments (think fillings) are also often covered at a high percentage.
Major dental care (crowns, bridges) will typically be covered at 50% or less. Some policies will even exclude coverage. Cosmetic treatments are almost never covered. If you want to whiten your teeth, get veneers, or change tooth shape, you’ll likely need to cover the full bill.
What About Orthodontics?
Many people assume that if they have dental coverage, anything involving the teeth is included — but this isn’t the case. Orthodontics is considered separate from general dentistry, so not all dental policies cover it.
But what if you have a policy that does include orthodontic coverage? Well, you still might be stuck paying for treatment out of pocket. First, many policies exclude adults from orthodontic coverage. Second, many adults are looking to correct cosmetic misalignments, which will usually not be covered.
If your policy does offer orthodontic coverage to adults and you are looking to make changes that will improve your oral or overall health, your policy might pay for up to 50% of the cost of treatment. Just watch out for lifetime limits; many policies cap orthodontic benefits at a set amount, such as $3,000.
Key Terminology to Know
Before you can understand your out-of-pocket costs, you need to be able to decipher your policy. The problem is that we aren’t all versed in insurance jargon. To give you a solid foundation, below are the most important terms to know.
- Deductible: Unless you have a high premium, no deductible policy, you’ll have to spend a certain amount of money out of pocket before your benefits kick in. So if you have a $1,000 deductible you haven’t paid on and a $500 procedure, you’ll pay the full cost on your own.
- Copay: Short for copayment, this is a specific amount you need to pay for office visits and procedures once you’ve met your deductible. The amount can be stable across the board or vary between types of visits and procedures.
- Coinsurance: Some policies have copays; others have coinsurance, and some have both. Coinsurance is a percentage of the cost of treatment that the patient is responsible for. Like copays, it can change based on the specific procedure.
- In-Network vs Out-of-Network: In-network providers are dentists and orthodontists who partner directly with your insurance company. Out-of-network providers are those who aren’t affiliated with your insurer. In-network providers are covered at higher rates and they handle the insurance paperwork for you. Out-of-network providers may not be covered at all and won’t do the paperwork for you.
How to Get Orthodontic Coverage with Aetna
Orthodontic coverage isn’t something that needs to be purchased separately — it is either included in an Aetna plan or it isn’t. You can enroll in a plan in one of two ways: through your employer during open enrollment or at any time of year through the insurance marketplace.
Employer-sponsored plans aren’t perfect, but if your company offers one that meets your needs, it is likely the better choice. Since your wages go towards premiums before they’re taxed, you save money when it’s time to pay Uncle Sam. In many cases, your employer will also pay toward the cost of your premiums.
The drawbacks to keep in mind here are related to the limitations of these policies. First, you can only get the level of coverage your company offers. If their plans don’t meet your needs, you can’t build one that’s right for you. Second, you can only enter into a plan during open enrollment, which means you might wait a year to enjoy coverage. And this is assuming your employer offers dental plans; not all do.
The alternative to an employer-sponsored dental plan is to purchase one individually on the insurance marketplace. This allows you to shop around for the policy that offers the right level of coverage for your budget. Aetna offers individual plans in most states, but we recommend shopping around as other providers may offer more generous orthodontic benefits in your state.
Save on Orthodontics Without Traditional Insurance
For those without dental insurance or with a plan that doesn't cover orthodontic treatments, DentalPlans may offer an appealing alternative. This service helps connect individuals with dental savings plans, an option that can provide more flexibility than traditional insurance.
These plans, which offer potential savings of up to 25% on orthodontic treatments, are designed to meet the needs of those struggling with high out-of-pocket costs. DentalPlans takes into consideration your unique circumstances, to help identify the most suitable plan for your needs.
Aetna Invisalign Coverage
Your Aetna plan might cover your Invisalign treatment, although it depends entirely on the plan. Some plans will cover around 50% of adult orthodontic treatment (including Invisalign), while others will only cover children up to 19 years old. Even if you receive coverage, there might be additional limitations, like a lifetime limit or a waiting period. Neither Aetna DMOs nor Aetna PPOs are a surefire bet for orthodontic benefits, but both have certain plans that cover orthodontics for children and adults.
Since ClearCorrect, SureSmile, and 3M Clarity are similar to Invisalign, they might also be partially covered, depending on your plan. Six Month Smiles typically treats milder cases, so it’s more often considered a cosmetic procedure, but not always! You’ll have to check with the company and your dentist to find out.
Aetna Braces Coverage
Aetna usually treats Invisalign and braces the same way for orthodontic coverage. So, your DMO or PPO plan might partially cover them. Go over your plan’s details to know for sure.
Lingual braces and clear braces fall into the same boat since they’re used to treat the same kinds of conditions. Six Month Smiles, however, usually treats milder, cosmetic cases, so they might not be covered. You’ll need to check with Aetna to find out.
Remember that you’ll need to get treatment from a dentist or orthodontist in Aetna’s network to receive the full amount for your coverage.
Aetna At-Home Clear Aligners Coverage
Aetna has a partnership with SmileDirectClub that brings the at-home aligner company into their PPO network. They don’t have partnerships with any other home aligner providers, but this might mean that they’re more open to covering home aligner treatment in general.
Of course, you shouldn’t assume that you’ll receive coverage just because some of Aetna’s plans partially cover SmileDirectClub treatment. It all depends on your specific plan, so you should check first before beginning treatment. Some home aligner companies — like Byte and SmileDirectClub — will check for you, while others leave it up to you.
How to File a Claim
If you choose in-office treatment with an in-network provider, you don’t need to worry about how to file a claim; your dentist’s or orthodontist’s office will handle the full process for you. With remote treatments and out-of-network providers, things can get a little trickier.
Out-of-network providers and most remote aligner companies will require you to file your claims on your own, though there are exceptions. For example, SmileDirectClub will handle the basics for you, and Byte takes care of the entire process from start to finish, including filing appeals when needed.
Most people haven’t filed a dental claim on their own, so Aetna provides some resources to help out, like a downloadable dental claim form (with instructions) and a Claim Tips & Guidelines page. You’ll likely need information, bills, or a summary of treatment from your dentist or orthodontist to complete the process.
After you’ve filed your claim, the insurer will process it in a few weeks, or it could take a couple of months.
Other Options if You’re Not Covered
Even though Aetna has plenty of plans that offer some form of orthodontic coverage, there are plenty more that don’t. You can potentially enroll in a supplemental plan with orthodontic benefits from another company, but otherwise, you would need to switch to an Aetna plan that includes them (assuming that one is available). To do so, you’d have to wait for the next special or open enrollment period, then potentially wait longer if your plan has a designated waiting period. But if your condition isn’t urgent, it might be worth the money you’ll save.
If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use either — or both — to pay for your treatment. Both types of accounts let you save pre-tax income and then use it to pay for qualifying medical and dental expenses. Even if you have insurance, you can use these accounts so long as you don’t double- or triple-bill between them.
If your costs are still a bit much after insurance, FSA, and HSA funds, you can look into financing. Most dental and orthodontic offices will have payment plans and financing options, and nearly all at-home aligner companies have financing, too. If not, you can contract with third-party financiers like CareCredit. Just keep in mind that financing often means paying more over time.
It appears that Aetna Dental casts a wider net of coverage for orthodontic treatment than some competitors, especially for home aligners. Recognizing the growing market for at-home treatment, they’ve established a strategic partnership with SmileDirectClub and might be open to covering treatment from other companies as well. Still, it all depends on your specific plan, so check with your home aligner company or insurance provider before committing to treatment.
Once you know the details of your insurance plan and whether it covers your treatment, you can confidently develop a plan of action. Then, you’ll be on your way toward an orthodontic treatment that fits your condition and budget.
Frequently Asked Questions
Why are dental policies separate from health insurance?
It comes down to the way the two fields have diverged from the start. When general medicine started to become standardized, oral health wasn’t seen as important, while those in the dental fieldfelt that it was. Both forms of care developed their own schools, techniques, and professional associations, and insurance followed suit, separating the two.
Is it better to get a policy through an employer or on your own?
If your employer offers a policy that meets your needs, that will be the better financial decision. Employer-sponsored plans remove the cost of premiums from your wages before your income is taxed, which lowers what you owe the government each year. Additionally, many employers will cover a portion of your premium, reducing the financial burden of carrying dental insurance.
What is an open enrollment period?
This refers to the period each year when you can enter into an employer-sponsored insurance policy (or modify or cancel an existing one). This almost always happens in the fall, with new policies and changes taking effect at the start of the following calendar year.
What is teledentistry?
This term refers to dental and orthodontic services that are rendered remotely rather than in-person. This can include phone and Zoom consultations, using apps and scopes to monitor progress, and at-home clear aligners.
What makes some insurance companies hesitant to cover at-home aligners?
It mostly comes down to them not including in-person oversight. Without in-person check-ups, invisible complications, like root resorption, can go unnoticed. These complications are rare with any orthodontic treatment, and since at-home aligners make smaller shifts, they’re even less common. Still, it’s this risk that gives most insurance companies pause.
If I have orthodontics coverage, how much should I expect to pay out of pocket?
We can’t say because of all the variables at play. First, there is the cost of your treatment, which depends on its own variables. Then there is the matter of your deductible, copay, and coinsurance. You also have to see if your provider is in or out of network and what percentage of orthodontic treatment is covered, as well as your lifetime coverage limit.
Even if Aetna doesn’t cover at-home aligners, could they be the better choice?
In some cases, at-home aligners can be cheaper than traditional orthodontics, even when insurance will help with the latter and not the former. You have to really dig into the actual costs of treatment and compare.
If my policy doesn’t include orthodontic coverage, can I add it on as a rider?
Usually, this is not an option. However, it doesn’t hurt to ask your insurance company about the possibility.
What are reasons adults are denied orthodontic coverage?
Usually, it’s just a matter of age: most policies restrict orthodontic coverage to children and teens. The other top reasons for an insurer to deny orthodontic coverage to an adult is their case is cosmetic in nature or they’ve exhausted their lifetime benefits.
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