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 quite as widespread. 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 your clear aligner or braces treatment will be covered, but there’s also a chance they won’t be. Before you dive into treatment, read this guide for an in-depth look at BCBS’s coverage and instructions on how you can 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 severity, your dentist or orthodontist’s rates, 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 Blue Cross Blue Shield
First, we should note that BCBS 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 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 slightly.
Some of Blue Cross Blue Shield’s plans come with orthodontic benefits built in, while others don’t. You may have the opportunity to add orthodontic coverage to any plan, but not every company offers this option. 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.
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 don’t tend to cover Invisalign, or they only cover treatment for anyone under age 19.
But some of the more expensive plans (PPO Plus, etc.) will 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’s up to the specific company.
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 almost always 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%, 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 they might not be covered. 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, specifically, has established partnerships with byte, Candid, and SmileDirectClub, so those treatments are considered in-network. This doesn’t mean that every Anthem 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 as well as treatment from byte, Candid, or SmileDirectClub. You might be covered.
What about BCBS plans that aren’t under Anthem? You could still get your treatment covered, but again, you’ll have to see if you have orthodontic benefits.
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 BCBS. 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.
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 the claim form for your particular company and you should find some helpful information.
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 company 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
What happens if your insurance plan doesn’t cover the treatment you want? You have the option of switching insurance plans, but you’ll need to wait for an open enrollment period and some plans have a waiting period before you can start using your new benefits. So, you’ll need to decide if the coverage is worth the wait. Some of Blue Cross Blue Shield’s plans also allow you to add orthodontic benefits to an existing plan, but that’s not an option for everyone.
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 Blue Cross Blue Shield, you could use an HSA or FSA account to pay the remaining balance.
If you can’t find coverage, you can always 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).
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.