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 orthodontic is a different ball game. First of all, it’s more expensive than your typical routine dental services. But it’s also 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.
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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.
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 Cigna
Cigna doesn’t provide standalone orthodontic benefits. You’ll only receive it as part of your complete dental insurance package. Some insurance companies have options to add on supplemental orthodontic benefits, but Cigna does not. If your plan doesn’t include orthodontia and you want to enroll in a different one, 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.
Cigna Invisalign Coverage
Cigna has three 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 12 months before you can take advantage of the benefits. Additionally, there’s a $1,000 lifetime maximum per person.
If you have Cigna Dental 1000 or Cigna Dental Preventive, you won’t receive coverage for any orthodontic treatment.
Since ClearCorrect is a similar treatment to Invisalign, it might also be partially covered under the Cigna Dental 1500 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.
Cigna Braces Coverage
Just like Invisalign, braces are only covered under the Cigna Dental 1500 plan, not the Cigna Dental 1000 or Cigna Dental Preventive plans. Under the 1500 plan, Cigna will cover 50% of your orthodontist’s fee for braces, but you’ll have a 12-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 or not they fall under the company’s orthodontic benefits.
In a recent press release, SmileDirectClub claimed that Cigna plans may cover their treatment. However, patients have reported in online forums that Cigna denied their claims for at-home aligner treatment.
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.
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 Cigna. 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.
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 file a claim?” page.
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
If you’re currently under the Cigna Dental 1000 or Cigna Dental Preventive plan, your orthodontic treatment won’t be covered. So, what are your options? You could always try to switch to the Cigna Dental 1500 plan, but you would need to wait for an open or special enrollment period. Then, you’d have to wait another year before using the benefits, since that plan has a 12-month waiting period. However, if your condition isn’t urgent, the savings might be worth the wait.
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 Cigna, 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).
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.