Blue Cross Blue Shield (BCBS) is one of the nation’s largest health insurance providers. They have numerous companies under their umbrella and insure millions of Americans. But their orthodontic coverage isn’t exactly robust. If you’re considering braces, Invisalign, or at-home aligners, you might be wondering if your BCBS plan will help you out. The answer? It depends.
If you have Blue Cross Blue Shield, there’s a chance that they’ll cover your clear aligner or braces treatment, but there’s also a chance they won’t. Before you dive into treatment, read this guide for an in-depth look at BCBS’s coverage and instructions on how to use it.
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Average Costs Before Insurance
Orthodontic treatment prices certainly aren’t cheap, but they can vary significantly based on your condition’s severity, your dentist or orthodontist’s rates, and the type of treatment you choose.
Invisalign has a standard price of $3,000–$8,000, though it is possible your cost will fall outside this on either end. You might not be impressed by such a large range while figuring out where Invisalign fits into your budget but understand that there are many factors that increase or decrease the cost of treatment. The severity of your condition, the number of aligners needed, your dentist’s experience with Invisalign, and even where you live can all factor into the price.
Read through our true cost of Invisalign guide for a closer look.
Other In-Office Aligners
Invisalign might have pioneered mainstream clear aligner treatment, but they don’t have the market cornered. ClearCorrect is one of their top competitors and has been around since 2006. They have lower lab fees, which tend to keep their prices lower, too. Most people pay between $3,000 and $5,000 for treatment.
SureSmile and 3M Clarity are two other widely available options. Between the two, SureSmile has the lowest price range — usually $2,000–$6,000. Clarity matches Invisalign in price but exceeds it in scope of treatment, which can make it worth it in certain cases.
At-Home Clear Aligners
When it comes to affordability, no orthodontic treatment matches at-home clear aligners. These aligners are very similar to in-office options, except they are more limited in their scope of treatment and administered remotely. Most companies use a flat-rate pricing structure — meaning you pay the same amount no matter how many aligners you need — and treatment usually falls somewhere in the $1,200–$2,500 range.
Our top-ranked remote aligner provider is Byte. They have a sticker price of $1,999 for their all-day aligners and $2,399 for Byte At-Night. They aren’t the most affordable but they offer a lot of value for the cost, with treatment plans that average four months and a lifetime smile guarantee. And unlike most at-home aligner companies, they handle the entire insurance process for you. Check out our guide on insurance coverage with Byte for more info.
Braces may not have the same draw as aligners but they are the most time-testing orthodontic appliance and have the widest scope of treatment. In some cases, they are more affordable than aligners, though more discreet and innovative options can outprice them. In most cases, you’ll pay $4,000–$6,000 for braces. There are a lot of factors that can increase or decrease that price, though. See our guide on the true cost of braces to get a clearer picture.
What Does Dental Insurance Usually Cover?
Dental insurance is highly varied between companies, and even between plans within the same company. This makes it difficult to say what it usually covers. Still, there are some commonalities that can serve as a guide.
First, understand how insurers classify dental procedures. They divide them into one of four categories: preventative, basic, major, and cosmetic. Preventative care is the core of dental insurance, so most plans will cover any treatment that falls under this umbrella. Basic care is also generally covered — think fillings, root canals, and gum disease treatment.
Major procedures like crowns and bridges are less likely to be covered, and when they are, generally not in full. Cosmetic treatments are rarely, if ever, covered. Don’t expect insurance to help with the cost of whitening, veneers, or tooth shaping.
What About Orthodontics?
Orthodontic coverage is separate from dental coverage, though part of the same policy. In other words, even if you have comprehensive dental coverage on your policy, you might not have any for orthodontics. And if you do, what is and isn’t covered depends on how your policy views the specific treatment.
Some insurance plans consider braces and aligners to be vital treatments, covering about 50% of the cost. Others consider them cosmetic, excluding them from coverage. Most plans will see them as both — an essential major treatment for patients with certain conditions and cosmetic for those whose alignment isn’t impacting their overall or oral health.
Key Terminology to Know
To understand your dental benefits and how much you should anticipate paying for treatment, you need to know the financial terms of your policy. Below are the top words and phrases you need to have a solid understanding of when navigating your policy.
- Deductible: This is the amount of money you need to pay out of pocket every year before your insurance will step in to pay. For example, if your procedure is $500 and your yearly deductible is $1,000, and you haven’t paid toward that deductible yet, you will need to pay in full.
- Copay: Short for copayment, this is a fee you pay for covered treatments and office visits. This can be a set fee across the board or might vary based on the procedure.
- Coinsurance: Coinsurance kicks in after you’ve met your deductible. It is a set percentage of the cost of treatment that you need to cover. It varies between procedures.
- In-Network vs. Out-of-Network: Dental providers who partner directly with an insurance company are in-network, receiving more coverage. They also handle the insurance process for you. When a provider doesn’t partner with a company, they are classified as out-of-network. Expect to pay a higher percentage for their services and to handle the insurance claims process on your own.
How to Get Orthodontic Coverage with Blue Cross Blue Shield
First, we should note that Blue Cross Blue Shield isn’t a single company. Rather, it’s a “national association of 36 independent, community-based and locally operated Blue Cross Blue Shield companies.” This includes well-known subsidiaries like Anthem and Empire. Your insurer’s name might be slightly different, but you’ll still receive BCBS insurance, although the plan details might vary.
Second, orthodontic coverage isn’t something you need to buy separately — it’s simply included in certain BCBS plans. There are two ways to enroll in a suitable BCBS plan: through your employer or by purchasing an individual plan.
Most adults with dental coverage get it through their employer or their spouse’s employer, though you can purchase a dental policy on your own as well. If you have both options available to you, you’ll need to weigh the pros and cons of each.
The primary advantage of an employer-sponsored dental plan is tax related. Your premiums are deducted from your wages before they are taxed, saving you money when it comes to paying Uncle Sam. Another big advantage is that employers will usually pay part of the cost, lowering your premiums.
But these plans aren’t without their drawbacks. For one, you have to go with the plans your employer offers, even if they aren’t the best fit for you. For another, you usually need to wait for open enrollment to get one. And this is assuming your employer offers dental insurance; not all do.
You might find that the right option is to take out an individual plan on your own. It won’t save you on taxes or premiums but you can select the ideal plan for your needs and enroll at any time. Blue Cross Blue Shield offers both employer-sponsored and individual dental plans. But before you enroll, take time to compare your options to ensure you’re getting the best deal.
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Blue Cross Blue Shield Invisalign Coverage
There’s a ton of variation in BCBS plan options because there are so many different companies under the umbrella. Your plan’s details will depend on which company operates in your state, and if you’re receiving insurance through your employer, which ones they’ve chosen. No matter where you’re located, BCBS’ basic PPO plans rarely cover Invisalign, or they only cover treatment for people under age 19.
But some of the more expensive plans might cover up to 50% of comprehensive orthodontia for adults too. In other cases, you might be able to add orthodontic coverage to your plan, but that depends on which plans your company offers.
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 typically considered cosmetic, but not always! You’ll have to check with the company and your dentist to find out.
Blue Cross Blue Shield Braces Coverage
Braces are in the same boat as Invisalign. BCBS often considers adult orthodontic treatment cosmetic, so basic plans won’t usually cover it. When they are covered, it’s usually around 50%, and there’s often a lifetime limit, although this depends on your plan. Other companies allow you to add orthodontic coverage to any plan for an extra fee. Again, there is a lot of variation between companies and plans, so you’ll need to check with your provider to know for sure.
Lingual braces and clear braces are covered the same way since they’re used to treat the same kinds of conditions. Six Month Smiles, however, is a short-term treatment for milder cases, so their braces might not be eligible. You’ll need to check with BCBS to find out.
Remember that you’ll need to get treatment from an in-network dentist or orthodontist to receive the full amount for your coverage.
Blue Cross Blue Shield At-Home Clear Aligners Coverage
It might come as a surprise, but sometimes BCBS plans cover home aligners. Anthem and Empire have established partnerships with Byte and SmileDirectClub, so those treatments are considered in-network. This doesn’t mean that every Anthem and Empire plan will cover home aligners. Plans that don’t have orthodontic benefits likely won’t cover at-home aligners either. But let’s say you have an Anthem plan that includes orthodontic benefits; then treatment from Byte or SmileDirectClub might be covered.
What about BCBS plans that aren’t under Anthem or Empire? You could still get your treatment covered, but again, you’ll have to see if you have orthodontic benefits.
How to File a Claim
If you get in-office treatment from an in-network provider, filing a claim is simple — you let your dentist’s or orthodontist’s office handle it for you. If you work with an out-of-network provider, you’ll need to get the right paperwork, fill it out, and file it on your own. Should your plan be employer-sponsored, your HR team might offer some assistance.
BCBS has numerous subsidiaries that operate in different states, and each one has its own forms and procedures. But many of those companies have claim filing instructions and forms on their websites. Just search for your particular company’s claim form.
Home aligner companies are typically classified as out-of-network providers unless they have a partnership with BCBS. Most companies will not assist with insurance claims, though both Byte and SmileDirectClub do. Byte is more hands-on, taking care of the process from start to finish. SmileDirectClub will verify coverage and help with filing claims.
After you’ve filed a claim, BCBS will process it, which can take anywhere from a few weeks to several months.
Other Options If You’re Not Covered
What if you’re ready to get started with braces or aligners, but your current insurance plan doesn’t cover the treatment you want?
You aren’t without options. And the first options to look into are Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs). These accounts save up pre-tax income and allow you to apply the funds towards qualifying medical and dental expenses. FSAs are tied to your employer, while HSAs can be accessed through an employer or independently. Additionally, you can use them on their own or in addition to insurance, as long as you don’t double-bill anyone.
Financing is another option for making the cost of treatment fit within your budget. Dental and orthodontic offices typically offer payment plans, and when they don’t, third-party financiers are an option. If you choose at-home treatment, most companies offer financing plans.
The top takeaway is that you can receive coverage for your adult orthodontic treatment. BCBS is a relatively friendly insurer for orthodontic treatment. Their Invisalign and braces coverage is comparable to other providers, but where they shine is in their partnerships with home aligner companies. If you have BCBS insurance and you’re pursuing at-home aligner treatment, you have a better chance of receiving coverage.
Insurance can sometimes seem like an enigma, especially when it comes to orthodontics. But once you know the ins and outs of your plan, you should have a good idea about which treatments will receive coverage and how you can take advantage. It’s always a good idea to consult your dentist, orthodontist, or at-home aligner provider about insurance coverage before diving into treatment.
Frequently Asked Questions
Why are dental policies separate from health insurance?
The root of this issue is decades in the past, back when medicine at large did not see dentistry as medical in nature. Dentists had to strike out on their own, and as a result, they formed different schools, practices, and professional associations. Insurance coverage followed suit, separating the two.
Is it better to get a policy through an employer or on your own?
If your employer’s plans fit your coverage needs, they tend to be better since you save money on taxes and your company might pay part of your premium. If they don’t fit your needs, you’ll be better off getting a policy independently.
What is an open enrollment period?
Essentially, it is a window of time that usually happens once a year where you can join, modify, or cancel employer-sponsored insurance coverage. Typically, it takes place in the fall for coverage that begins the following calendar year.
What is teledentistry?
This term covers and dentistry services that are rendered without a patient needing to be seen in the office. It can include video conferences, remote monitoring through apps, and treatment with at-home aligners.
What makes some insurance companies hesitant to cover at-home aligners?
Since they don’t involve in-person supervision, there is concern about things going wrong, especially invisible problems with the tooth roots. However, since these aligners don’t make large shifts, the risks are quite small — and that’s why more and more providers are offering coverage.
If I have orthodontics coverage, how much should I expect to pay out of pocket?
This depends on many factors. Variables that might impact your cost include:
- The treatment you select
- The dentist you work with
- The complexity of your case
- The percentage of treatment your policy covers
- If you’ve met your deductible
- What your copay and coinsurance are
- How many office visits you’ll need
Even if BCBS doesn’t cover at-home aligners, could they be the better choice?
It is possible that once you factor in all of the costs associated with in-office treatment, even with orthodontic coverage, at-home aligners will be the more affordable choice.
If my policy doesn’t include orthodontic coverage, can I add it on as a rider?
It is possible but not always an option. For example, if you have an employer-sponsored dental plan, you might not be able to add coverage that isn’t already included.
What are reasons adults are denied orthodontic coverage?
The top reason is age: most policies offer orthodontic coverage to teens and children, not adults. The next most common reason for denial is that they’ve already maxed out their lifetime benefits.
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