Are Candid Aligners Covered by Insurance?

Your dental insurance covered your last cleaning and the filling before that. You might’ve even used it for a root canal last year. So it should cover your teeth straightening treatment too, right? Not always. Getting coverage for Candid depends on a few different factors — primarily whether your benefits include teledentistry coverage.

We’ll start with the good news: depending on your specific insurance plan, you might receive coverage for a portion of your dentist’s price for Candid. But there’s also a chance that your insurer will deny your claim (even if you have orthodontic benefits). How can you know what to expect?

Read this guide. It will explain the insurance policies and procedures your dentist might have for Candid clear aligner treatment.

Candid Insurance Coverage: The Basics

Does insurance cover Candid? “Maybe” might not be the answer you want to hear, but it’s the truth. Insurance coverage for Candid clear aligners depends entirely on your insurance plan and your dentist’s policies.

Some insurance companies are open to covering clear aligner treatments that involve teledentistry, like Candid, while others will only cover in-office treatments like braces or Invisalign. And even if your company covers orthodontics, not every plan includes orthodontic benefits. To know for sure, review your plan’s details or talk to your provider.

But it also depends on your dentist. Many dentists accept insurance payments, but not all of them. If your plan includes orthodontic benefits, make sure your dentist is in-network for your provider and ask them if their office will accept your insurance. If so, great. If not, you may need to pay out of pocket or seek treatment elsewhere.

Does Health Insurance Cover Orthodontics?

It’s a logical conclusion: orthodontics can improve your overall health, so health insurance should cover it. Well, insurance treats your teeth, gums, and jaw differently than the rest of your body, so they require their own policy. Whether you are looking at remote aligners, in-office treatment, or a hybrid option like Candid, your general health insurance won’t help you cover the cost.

What If I Have Dental Insurance?

Dental insurance covers preventative care like semi-annual cleanings and other routine procedures (fillings, root canals, etc.). Depending on the policy, it can cover other treatments as well, including orthodontics, but that’s not by default. And even when you have orthodontic coverage, there are special considerations that might prevent your treatment from being covered.

• Lifetime Coverage Limits: Most policies place a lifetime limit on orthodontic coverage. Sometimes, this is per person; sometimes, it is per policy. Once you reach the limit, insurance will no longer pay toward orthodontic treatments. Most policies set this limit low enough that you will run through your benefits before paying the full price.
• Percentage Covered: As it ends up, most policies won’t pay for orthodontic treatment in full, even if there is no lifetime coverage limit. That’s because they usually only pay for a percentage of treatment. Expect this to be 50% or less. If you have a lifetime limit and hit it before reaching the percentage limit, that’s when coverage stops.
• Waiting Periods: Waiting periods are standard in the insurance industry. With dental policies, you usually need to wait 3–6 months before basic procedures are covered and 6–12 months for major ones. Orthodontic treatments are typically considered the latter.
• Age Restrictions: While anyone of any age could have orthodontic issues, many plans restrict coverage to patients 19 and younger. This is because treatment is easier, and thus cheaper, when the body is still growing, making it financially beneficial for insurance companies to only cover it for children and teens.

The key takeaway here? Even if you have a dental policy and orthodontic coverage, don’t assume it means your company will pay for part or all of the cost of Candid.

Is Candid Covered Differently Than Braces or Invisalign?

Next scenario: You have dental insurance and orthodontic benefits and the above issues either don’t apply or aren’t a concern for you. In this case, there’s a chance you could receive insurance coverage, but it all depends on your specific plan and dentist.

You’ll receive your Candid clear aligners in person from one of their 800+ providers, and even though your dentist will monitor your progress remotely for part of your treatment, many insurance companies will classify it under insurance code D8090 — the same as Invisalign and other in-office aligners. That means that they’ll often cover a portion of your treatment, although that varies based on your plan and whether you’ve already used your orthodontic benefits for other treatments.

However, some providers only place treatments in this category if they involve routine office visits, in which case they may not cover Candid. The only way to know for sure is to speak with your dentist and contact your insurance provider.

How Do I Get Orthodontic Benefits?

Orthodontic coverage isn’t something you need to buy separately — it’s simply included in certain plans. There are two ways to enroll in a suitable dental plan: through your employer or by purchasing an individual plan.

Most adults in the U.S. with dental insurance receive it through their employer (or their spouse’s employer). There are a couple of advantages to enrolling in dental insurance through an employer plan. For one thing, insurance premiums get deducted directly from your wages before tax, reducing what you owe. For another, employers often contribute toward the cost of their plans, which results in lower premiums.

Employer-sponsored dental plans have their drawbacks though. First, you’re limited to the plan options offered by your employer. This can be especially problematic if you’re interested in braces or clear aligners, as many dental insurance plans do not cover orthodontics, or offer very limited coverage. Second, employer-sponsored dental plans are often bundled together with health plans, so you may need to wait for an “open enrollment” period to modify your plan. Lastly, many companies simply don’t offer dental insurance at all.

Fortunately, even if you receive health and/or dental coverage through your employer, you can always invest in an individual plan that covers orthodontics, too. And unlike buying standard health insurance, you don’t have to wait for an open enrollment period to purchase an individual dental/orthodontics plan — you can enroll at any time of the year!

How Do I Claim My Benefits?

You don’t really have to do anything. One of the nice parts about receiving treatment through a dentist’s office is that they will file insurance claims for you, as long as your dentist accepts your insurance.

Here’s how it works: Your dentist’s office will send a claim to your insurance provider, who will review it and compare the treatments provided to those covered by your plan. If they provide coverage, they will send back a payment, which your dentist will deduct from your bill. Then, the office will send you an “Explanation of Benefits,” which outlines the services and insurance coverage, followed by a final bill.

Compare your bill with your Explanation of Benefits document and make sure that everything lines up. And if you have any questions, reach out to the insurance company for clarification.

Other Ways to Manage Orthodontic Costs

If your plan doesn’t include orthodontic benefits and you don’t have any other options, you might be out of luck on the insurance front. But don’t worry; there are still ways to make Candid’s price more accessible.

Enroll in a Dental Discount Plan: Certain providers may also offer dental discount plans (or dental savings plans). These are not insurance plans. Rather, they’re like a subscription where you pay a monthly or annual fee and receive discounts on certain procedures or designated dentists. Sometimes these plans include orthodontic treatments.

Shop Around: Different dentists have different rates. And if you live near multiple Candid providers, there’s nothing wrong with getting multiple estimates to compare prices. Just make sure that the dentist you choose is in your insurance provider’s network or you might not receive coverage.

Look into Financing: Most dental and orthodontic offices offer some type of financing plan. Some provide in-house payment plans, while others partner with third-party companies. If you’re considering financing your treatment, be sure to do your research and read the fine print. Most third-party plans include interest, so you’ll end up paying more in the long run — in some cases, significantly so. When you make your initial office visit, ask your dentist for details on their in-house financing options, as these often have better terms.

Consider Other Clear Aligners: If you like the appearance of clear aligners but Candid’s price seems a little steep, you might consider getting clear aligners from another at-home aligner provider like Byte, AlignerCo, or SmileDirectClub. They’re a less expensive alternative that can treat mild-to-moderate cases of crowding, spacing, and even some bite issues.

What About HSAs and FSAs?

Whether you use the funds in conjunction with insurance or on their own, Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) can both make Candid easier on your budget. These accounts let you put away pre-tax income to use later for medical expenses. Most dental offices will accept payment from these accounts.

If so, you can pay for your treatment directly from one of these accounts, whether or not you’ve received any insurance coverage. If your account is linked to a debit card, just use it like you would any other card. Otherwise, reach out to your dentist’s office for assistance.

Just remember that FSA funds don’t roll over year to year the way HSA funds do. If you want to use this money for your Candid treatment, do so before it expires.

Final Thoughts

If you’re considering Candid treatment from a local dentist, don’t rule out insurance coverage! Customers receive reimbursements more often than you might think. While Candid doesn’t have as many in-network partnerships as some competitors, you can still significantly reduce your treatment expenses.

Of course, it all depends on your specific provider and plan, so check with the insurance company and your dentist before you do anything else. Once you’ve got that squared away, you’ll have a better sense of your total Candid price and one step closer to beginning your smile journey.