You’ve likely been to plenty of routine cleanings, had a few fillings, and maybe a root canal or two. And if you have dental insurance, you might not have had to pay for a whole lot of it. But orthodontic treatment is different because it’s not always covered. Your insurance plan might provide orthodontic benefits, or it might not. Before jumping into teeth-straightening treatment, you should understand 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 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.
Table of Contents
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.
On average, your Invisalign treatment will cost somewhere between $3,000 and $8,000. That’s a pretty big range, but only because the price is subject to several influencing factors. Your condition severity, treatment length, dentist’s expertise, and even where you live can affect your final price. Read through our true cost of Invisalign guide for a closer look.
Although Invisalign is the original clear aligner producer, they’re no longer the only one. ClearCorrect hit the scene in 2006 and has been a worthy competitor ever since. They charge less for lab fees than Invisalign does, so their prices can be slightly lower, often in the $3,000 – $5,000 range (although up to $8,000 is possible too). Then there’s Six Month Smiles, who offer clear braces and aligners that treat minor cases in, you guessed it, six months. Despite being a shorter treatment, Six Month Smiles often costs $3,500 – $5,000, according to their website.
At-Home Clear Aligners
While Invisalign must be administered in a dentist or orthodontist’s office, at-home aligners let you complete treatment (you guessed it) at home. A remote dentist will design your treatment and you’ll receive all of your aligners in the mail, then follow your treatment plan to gradually shift your teeth.
The appeal of at-home clear aligners is in large part due to their affordability. They’re often thousands cheaper than in-office clear aligner treatments, around $1,500 – $2,500 on average. Unlike Invisalign and ClearCorrect, home aligners come at a flat rate. The only difference is which company you choose. For example, SmileDirectClub is always $1,950 while AlignerCo is $1,145.
Our top-ranked provider is byte, which costs $1,895 for standard treatment and $2,295 for byte At-Night. They don’t have the absolute lowest price on the market, but their average 3-month treatment time is the industry’s fastest and their byte-for-life guarantee are unmatched. Plus, byte will walk you through the entire insurance process, from initial coverage checks to claims and anything else you might need, making it a whole lot easier. Check out our guide on insurance coverage with byte for more info.
The most time-tested orthodontic treatment can also be one of the most expensive. Traditional braces typically fall somewhere in the $4,000 – $6,000 price range, although that price depends on a few factors (see our guide on the true cost of braces). Like Invisalign, the exact amount depends on your condition severity, orthodontist’s rates, and where you live.
It also depends on the type of braces you choose. You have a few options: traditional braces, lingual braces (which sit behind the teeth), clear/ceramic braces, and Six Month Smiles braces. Specialty braces (lingual, clear) often cost more than traditional ones. Lingual braces, for example, can cost up to $10,000.
What Does Dental Insurance Usually Cover?
Insurance companies often classify dental procedures into one of four categories: preventive, basic, major, and cosmetic.
Most plans cover 100% of your preventive treatments like cleanings. They might also completely cover basic treatments like fillings, gum disease treatment, and root canals, or they might provide something like 75% coverage. Major treatments like crowns and bridges are usually covered at a lower rate, sometimes around 50%. Cosmetic procedures, like whitening, veneers, and tooth shaping are rarely covered by dental insurance plans. Of course, the percentages for each category depend on your specific plan.
Notably, clear aligners and braces are sometimes considered a cosmetic form of treatment, and other times they are considered a form of major treatment. Some plans will include orthodontic benefits that can help cover the cost of braces, aligners, or other procedures, while others do not.
Different providers and plans cover different procedures, so you shouldn’t assume that you’ll receive coverage for your treatment just because you have orthodontic benefits. Additionally, sometimes this coverage comes with an age limit or an annual or lifetime limit.
It’s also important to know some insurance terminology to fully understand your plan, like:
- Deductible: The amount you’ll need to pay out of pocket before insurance begins to pick up the tab. If you have a $100 procedure, but your deductible is $500 and you haven’t paid any of it yet, you’ll need to pay for the entire procedure.
- Copay: Short for copayment. A set amount that you’ll pay for certain covered treatments. Copays can vary based on the procedure.
- Coinsurance: The percentage of treatment costs you’ll need to cover after you’ve met your deductible. It also varies based on the procedure.
- In-Network vs Out-of-Network: Dental providers often partner with insurance companies to provide “in-network” coverage. When your dental provider is in-network with your insurance provider, coverage rates are typically higher and your dental provider will handle the insurance paperwork for you. With out-of-network care, coverage rates are often lower, and you may need to request reimbursement from your insurance provider directly.
How to Get Orthodontic Coverage with Aetna
With Aetna, orthodontic benefits aren’t something you can tack on after the fact. Their plans either have it included or they don’t. Other insurance providers offer supplemental orthodontic benefits you can add for an extra fee, but Aetna doesn’t.
If your plan doesn’t include orthodontia and you want to enroll in a different one (if there’s an option that includes it), you’ll typically need to wait for an open enrollment period, unless you’ve experienced a qualifying life event, which most commonly includes:
- Changes in household (marriage, divorce, birth, death)
- Changes in residence
- Loss of health coverage
- Becoming a U.S. citizen
Like many others, you might receive dental benefits through your employer. When providing health and dental insurance, employers select certain plans to sponsor, and yours may or may not have chosen ones with orthodontic benefits. If you would like to receive orthodontic coverage, but your employer doesn’t offer a plan that includes it, you can always reach out to Human Resources to see if they might consider changing or adding plans.
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. When treatment is covered, there might be additional limitations, like a lifetime limit or a waiting period before you can access the coverage. Aetna DMO and Aetna PPO both have plans that cover orthodontics for children, while adult coverage comes more often with DMO plans.
Since ClearCorrect is a similar treatment to Invisalign, it 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 when it comes to orthodontic coverage. So, if you have a DMO plan, there’s probably a better chance that part of your treatment will be covered than if you have a PPO plan. But you should go over your plan’s details regardless.
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 could be an indication 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 cover SmileDirectClub treatment. It all depends on your specific plan, so you should check first before beginning treatment. Some home aligner companies—like byte, Candid, and SmileDirectClub—will check for you, while others leave it up to you.
How to File a Claim
For in-office treatments like braces and Invisalign, your dentist or orthodontist’s office will file an insurance claim on your behalf, so you don’t have to worry about any paperwork or other correspondence. They’ll only do this, however, if they are “in-network” with Aetna. If you choose an out-of-network dentist or orthodontist, you may need to file the claim yourself. If you receive insurance through your employer, their H.R. department may be able to walk you through the process.
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.
Home aligner companies may or may not. byte, for example, will walk you through the entire process. They’ll fill out your claim so that there are no mistakes and they’ll also handle any ongoing communication or appeals with the insurance provider. SmileDirectClub and Candid will also help you check on your coverage and file claims, but they don’t go quite as far as byte.
Other companies leave the insurance process up to you. In these cases, you’ll need to download the correct claim form for your insurance provider and fill it out completely. Contact the home aligner company with any questions because a single mistake on your form can get your claim denied.
After your claim is filed, 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. There’s no option for supplemental orthodontic benefits, so you can’t add them on after the fact. Instead, you would need to enroll in a plan that includes them (assuming that one is available). To do so, you would need 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 one to pay for your treatment. These accounts deduct money from your income before taxes and lets you use it for qualifying medical and dental expenses. They’re often an option with plans sponsored by employers, and if you have one, you can use its funds to pay for your orthodontic treatment. Even if you received partial coverage from Aetna, you could use an HSA or FSA account to pay the remaining balance.
Otherwise, you can look for other ways to make the price tag more manageable, like financing plans. Dentist and orthodontist offices will usually offer payment plans, as will most at-home aligner companies, although a credit check might be necessary to qualify. Or, you can check out third party options like CareCredit, which provide financing specifically for medical and dental expenses (these plans often require a credit check too).
It appears that Aetna Dental casts a wider net of coverage for orthodontic treatment than some competitors, especially when it comes to 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.