Does Cigna Cover Braces & Clear Aligners?

When you enroll in a Cigna dental insurance plan, you get coverage for a variety of dental treatments, which should inspire some confidence when scheduling office visits. But orthodontia is a different ball game. First of all, it’s more expensive than your typical routine dental services. Second, it’s not as widely covered. Some insurance plans cover it and others don’t.

If you’re considering teeth-straightening treatment, you’ll need to study the details of your plan to get a sense of what you might pay. This guide is your perfect starting point. It’ll give you all the foundational information about Cigna insurance that you need to plan out your treatment and prep your finances.

Cigna Invisalign Coverage

Cigna has six main dental insurance plans, but only one of them provides orthodontic benefits: Cigna Dental 1500. These benefits include Invisalign and will cover 50% of the provider’s contracted fee, but the coverage comes with limitations. After enrolling in the 1500 plan, you’ll need to wait twelve months before you can take advantage of the benefits. Additionally, there’s a $1,000 lifetime maximum per person.

If you have one of their other plans, you won’t receive coverage for any orthodontic treatment.

Since ClearCorrect, SureSmile, and 3M Clarity are similar to Invisalign, the Cigna Dental 1500 plan might also cover them. 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.

Cigna Braces Coverage

Just like Invisalign, braces are only covered under the Cigna Dental 1500 plan, not any others. Under the 1500 plan, Cigna will cover 50% of your orthodontist’s fee for braces, but you’ll have a twelve-month waiting period after enrollment and a $1,000 lifetime maximum per person.

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 Cigna to find out.

Cigna At-Home Clear Aligners Coverage

Cigna doesn’t address at-home aligners in their plans or on their website, so it’s unclear whether they fall under the company’s orthodontic benefits. They have a telehealth platform, but the dentistry services don’t include orthodontics.

SmileDirectClub claims that Cigna plans may cover their treatment. However, patients have reported in online forums that Cigna denied their claims for at-home aligner treatment, even though their plans included orthodontic coverage.

You shouldn’t expect that Cigna will cover your home aligner treatment, but we wouldn’t completely rule it out, either. To find out for sure, you or your home aligner company will need to contact them directly to discuss the details of your insurance plan.

Average Costs Before Insurance

Before you can figure out how much your Cigna insurance will cover, you’ll need to know what kind of prices you’re working with. Orthodontic expenses can vary significantly depending on your condition, your dentist or orthodontist’s rates, and what type of treatment you choose.

Invisalign

Invisalign, like all in-office treatments, doesn’t come with a set price. To know what you will pay, you have to schedule a consultation. That said, most people pay somewhere between $3,000–$8,000 for Invisalign treatment. Factors impacting price include everything from the complexity of your case to where you live. Read through our true cost of Invisalign guide for a closer look.

Other In-Office Aligners

Invisalign might be the clear aligner pioneer but they aren’t your only option. ClearCorrect is one of their top competitors, having hit the scene back in 2006. It isn’t as easy to find a provider, but if you can, you’ll likely spend less than you would with Invisalign — this system has a typical price range of $3,000–$5,000. SureSmile is another competitor, known for its customization options. It typically costs $2,000–$6,000. Then there is 3M Clarity, which has the same price range as Invisalign but can treat a slightly wider range of conditions.

At-Home Clear Aligners

Not all orthodontic treatment must be rendered in-office. At-home aligners are strictly remote treatment (save for in-person scans offered by some providers). A licensed dentist or orthodontist supervises the creation of treatment plans and all your aligners are delivered by mail. You just wear them according to the directions and steadily shift your teeth. They’re more convenient than traditional treatment, but also more affordable — $1,200–$2,500 on average.

Byte is our top-ranked provider and has a flat rate of $1,999 for all-day treatment or $2,399 for night-only aligners. They aren’t the most affordable but they offer a great value for the price. On top of this, they handle insurance claims from start to finish, making it easier on you. Check out our guide on insurance coverage with Byte for more info.

Braces

Braces are perhaps the most time-tested method for straightening teeth — and depending on the type, they can be the most expensive. Standard braces are usually 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?

Every dental insurance provider has their own terms, and if they offer multiple policy tiers, there will be variations between coverage there as well. Most companies classify dental procedures into one of four categories: preventative, basic, major, and cosmetic.

Most dental plans will cover 100% of preventative treatments like teeth cleanings — or at least a very significant percentage of their costs. This makes sense from a profit perspective; the insurance company pays for affordable treatments to avoid covering more expensive ones down the road. Basic treatments, such as fillings, are also usually covered in full or at a high percentage.

They usually cover major dental care — think crowns and bridges — at a rate of 50% or less, and some policies exclude coverage. Cosmetic treatments are rarely, if ever, covered, so expect to pay for in-office whitening, veneers, and similar treatments out of pocket.

What About Orthodontics?

Orthodontics aren’t automatically covered under dental policies. You need to have one with orthodontic coverage to get help with the cost of treatment — but even that doesn’t mean your insurer will pay for braces or aligners.

Orthodontics can be a major treatment. It can also be a cosmetic one. It all comes down to the nature of your misalignment. If changing your tooth position can improve your oral or overall health or stop issues like tooth decay from developing, you might receive up to 50% coverage. But if you are just looking to close a small gap or something similar, you probably won’t get help from your insurance company.

Key Terminology to Know

Navigating insurance coverage can be daunting, and the jargon plays a big role in this. To understand your coverage, you need to know the terms. Below are key phrases to understand before you dig into your paperwork.

• Deductible: Your deductible is the amount of money you must pay toward your dental expenses each year before your insurance kicks in. So, if you need a $500 procedure but have a $1,000 deductible you haven’t paid anything toward yet, you’ll have to foot the full bill.
• Copay: Short for copayment, this is the cost you’ll pay for office visits and covered treatments after you meet your deductible. The cost may be the same across the board or vary by treatment.
• Coinsurance: Besides your copayment, you might have coinsurance. This is the percentage of treatment costs you have to cover. It kicks in after you’ve met your deductible, and the amount can vary by procedure.
• In-Network vs. Out-of-Network: In-network dentists and orthodontists are those who partner with your insurance. Usually, coverage rates are better for in-network providers, and their offices will handle your insurance claims. Out-of-network providers may not be covered and when they are, it will usually be at a lower percentage, with you needing to handle claims yourself.

How to Get Orthodontic Coverage with Cigna

To receive orthodontic coverage from Cigna, you must take out a dental policy that includes it. You can do this through your employer or by purchasing a plan directly from the company.

If your employer offers a plan that meets your needs, it’s probably the better option. They will deduct premiums from your wages before tax — saving you money come April 15th — and your employer will usually cover part of the cost. The downside here is that not all employers offer dental insurance, and if yours does, their plans might not be the perfect fit for you. Additionally, you have to wait for open enrollment to begin a plan.

If you can’t get employer-based coverage that works for you, you can take out a plan on your own. You don’t need to wait for open enrollment and you can select the ideal coverage level for your needs. Just keep in mind that you won’t get the same level of financial assistance as you would with job-based plans.

Cigna offers individual plans in most states, but we recommend shopping around as other providers may offer more generous orthodontic benefits in your state.

How to File a Claim

If you get in-office treatment from an in-network provider, you don’t need to worry about how to file a claim with Cigna; your dentist or orthodontist will handle it for you. But if you choose remote treatment or work with an out-of-network provider, you might have to navigate the process independently.

The claim process might seem intimidating if you’ve never done it before, but the good news is that Cigna offers instructions on their website. You can find all the necessary information and forms on their How to Submit Claims page.

If you work with an at-home aligner company, you might get some assistance. For example, SmileDirectClub will verify coverage and help with filing claims, and Byte will handle the insurance process from start to finish, including appeals. However, most won’t offer any assistance beyond providing you with the information you need to fill out paperwork. Once you file a claim, it can take anywhere from a few weeks to several months to get a response.

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 out of options just yet. If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use the funds to cover treatment — in many cases, at least. HSAs are available to anyone with a high-deductible health plan while FSAs are tied to your employer. You can use them to pay for any qualifying medical or dental expenses. Just verify with your account administrator if your orthodontic treatment is covered.

If these aren’t an option for you or your out-of-pocket expenses are still high, you can look into financing. Most at-home aligner companies offer their own plans, while many dental and orthodontic offices do, too. If your provider doesn’t have financing, you can look into a third-party option. If you do finance your treatment, be sure to do your research, since most of these plans include interest and can increase your total cost — in some cases significantly so.

Final Thoughts

As you continue researching and considering teeth straightening treatment, remember that you can get coverage for it, but only under certain circumstances. The Cigna Dental 1500 plan has fairly comparable orthodontic coverage to other insurance providers. Although it doesn’t seem like they go as far as a few of their competitors in covering at-home aligner treatment. Still, it can’t hurt to ask.

Once you understand your insurance plan’s details, you’ll have a much better idea about what you’ll pay for orthodontic treatment. It’s always a good idea to consult your dentist, orthodontist, or at-home aligner provider about insurance coverage before diving into treatment.