Maybe you’ve used your dental insurance to cover routine cleanings and fillings, but now you’re considering something bigger: teeth-straightening treatment.
If you’re unfamiliar with your insurance plan, you might think that it will cover orthodontics like any other treatment, but that isn’t always the case. The fact is that orthodontic benefits aren’t included in every dental insurance plan.
Lucky for you, there are ways to find dental insurance plans that include coverage for adult braces, Invisalign, and even online clear aligners like SmileDirectClub. How? With a few simple steps.
Table of Contents
Step One: Understand the Basics of Dental Insurance
Dental insurance isn’t a magical card that gets you free health care. Sure, it will cover some of your procedures and fees, but there’s a bit more involved. Many people enroll in dental insurance through their employers, but you can also enroll in individual or family plans. Either way, you can typically choose from a few different options, each with different benefits and policies.
Some plans include orthodontic benefits, while others don’t. Orthodontic benefits may cover braces, Invisalign, and even at-home clear aligners like SmileDirectClub, but they usually won’t cover the entire cost (many, for example, cover 50%).
They might also include certain restrictions. Some plans will cover orthodontia for children under age 19 but not adults. Others might have a lifetime spending maximum, where they’ll cover up to a certain amount (on average $1,500 – $3,000). Sometimes, a plan will also include a waiting period that would require you to wait a few months (or even a year) before using your orthodontic benefits.
Important Terms to Know
Insurance policies are filled with jargon, and this can make it difficult to decipher your coverage. While in an ideal world, you’d understand your policy clearly, word for word, to get started, we suggest familiarizing yourself with the following terms.
- Deductible: This is the amount you have to pay out of pocket each year before insurance steps in to help. For example, if you have a $1,000 deductible and need a $500 procedure, you’ll pay the full cost on your own.
- Copay: A shorter way of saying copayment, this references the amount you pay per office visit or procedure. The cost can be the same across the board or vary depending on how your treatment is classified.
- Coinsurance: Some policies use this as an alternative to copay, though some use both. It is a percentage of the cost of office visits and treatments that you are responsible for. Like copay, the amount can vary.
- In-Network vs. Out-of-Network: When a dentist or orthodontist is in-network, they partner with your dental insurance. When they are out-of-network, they aren’t affiliated. In-network providers are covered at higher rates and their offices handle the insurance paperwork.
Step Two: Choose a Preferred Treatment Option
Just because you have orthodontic benefits doesn’t mean you’ll receive coverage for every orthodontic treatment. For example, some plans might cover in-office treatments like braces and Invisalign, but not remote services like SmileDirectClub or Byte.
This is a common scenario, although several large insurance providers have begun offering coverage for certain online clear aligner companies. Here’s an overview of the main types of treatment that might be covered:
Adults are often drawn to Invisalign because it provides a power that’s similar to braces but without all the metal. But it can also be pretty expensive — $3,000 to $8,000 (on average) before insurance. If you have orthodontic benefits, however, they often cover Invisalign. Just be sure to check for age limits and lifetime spending maximums. You wouldn’t want to commit to treatment only to find out that your plan only covers Invisalign for people under age 19.
Braces coverage is usually the same as Invisalign. Orthodontic benefits will cover braces, but there might be age and spending restrictions. Without insurance, braces are around the same price as Invisalign, and sometimes slightly less expensive. If your insurance plan doesn’t include orthodontic benefits, your braces will probably be somewhere around $4,000 to $6,000. Of course, your bill might fall outside that range for minor or complicated conditions.
Tip: Learn more about how dental benefits work, whether they are likely to cover braces, and how to claim your benefits by checking out our comprehensive guide to insurance coverage for braces.
Online Clear Aligners
At-home clear aligners like SmileDirectClub aren’t always included in orthodontic benefits. Some insurance providers have formed partnerships that bring home aligner companies in-network:
- Byte has partnerships with Anthem, Aetna, Empire, and Guardian (and others, coming soon)
- SmileDirectClub partners with UnitedHealthCare, Aetna, and Blue Cross Blue Shield
Some other insurance providers refuse to cover at-home treatment from any remote aligner company. However, this situation is evolving quickly, and more providers are starting to include at-home aligners in their orthodontic benefits.
How To Get Coverage for Online Clear Aligners
If you’re interested in online clear aligners, check out our comprehensive insurance guides for some of the most popular options.
- Is Byte Covered by Insurance?
- Is SmileDirectClub Covered by Insurance?
- Is Candid Covered by Insurance?
- Is AlignerCo Covered by Insurance?
Tip: Our #1-rated clear aligner service, Byte, is the only provider that does the legwork for you when it comes to getting coverage for treatment.
Step Three: Research and Compare Providers and Plans
Which insurance companies cover orthodontic care?
Most insurance providers have at least one plan option with orthodontic benefits. What those benefits include can vary depending on the provider and plan. Different providers have different policies, networks, and restrictions. If you receive insurance through your employer, you might not have a say in which provider you get, but there might be a plan that will cover part of your treatment.
We’ve examined various insurance providers and their typical orthodontic benefits. Again, a lot depends on your specific plan, but these guides should help you get a sense of whether you’ll receive coverage from your provider:
- Does Delta Dental Cover Braces & Clear Aligners?
- Does Blue Cross Blue Shield Cover Braces & Clear Aligners?
- Does Aetna Cover Braces & Clear Aligners?
- Does MetLife Cover Braces & Clear Aligners?
- Does Cigna Cover Braces & Clear Aligners?
- Does Guardian Cover Braces & Clear Aligners?
- Does United Concordia Cover Braces & Clear Aligners?
Good Questions to Ask When Comparing Plans
If you plan to pursue orthodontic treatment in the future, you’ll want to select an insurance plan that has applicable orthodontic benefits. Here are some questions that will help you find the right one:
- What percentage of treatment costs will it cover?
- Is there a lifetime spending maximum?
- Is there an age limit?
- Is there a waiting period?
- Which orthodontic treatments does it cover?
- How big is the dentist/orthodontist network?
Step Four: Purchase a Plan
Many people receive health and dental insurance through their employers. When you begin a new job, you’ll have a chance to enroll in one of their insurance plans (during the next enrollment period). Be sure to consult the human resources office on the available benefits and policies before enrolling.
If you don’t have a job that offers benefits or you don’t like the plans your employer offers, you can always enroll in an individual or family plan. These usually have similar benefits, but you might have to pay higher premiums. You can find these plans on each insurance provider’s website or through healthcare.gov.
Some people get insurance through their employer, then add an individual plan to get more benefits. If your employer doesn’t offer a plan with orthodontic benefits, you can get a second plan that includes them. Of course, you would be paying for two plans, so you’d want to make sure that the money you’d save is worth it.
Looking For a Dental Plan That Meets Your Needs?
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In case you have questions or need assistance finding the perfect plan (e.g. one that covers braces/aligners), you can call into their support line and receive help from their knowledgeable, friendly staff.
Step Five: Consider Other Ways to Save
If your plan doesn’t include orthodontic benefits and you don’t have any other options, you might be out of luck. But don’t worry; there are still ways to save money on your treatment.
Dental Discount Plans: Also called a dental savings plan, this is a subscription-based service that some insurance companies offer. You pay monthly or annually and receive discounts on specific procedures from designated dentists. Sometimes, this includes orthodontic treatments, but not always.
Shop Around: The cost of in-office treatments isn’t set across the board; every dentist and orthodontist chooses their own rates. This means one doctor might be a lot more affordable than another.
Use an HSA or FSA Account: Designed to let you save pre-tax income and apply it to qualifying medical expenses, HSAs and FSAs can typically be used for orthodontics, though this might depend on if your case is cosmetic or not. Ask your account manager for details.
Tip: For more information about using an HSA or FSA to cover orthodontic treatment, check out our detailed guide dedicated to this topic.
Consider At-Home Aligners: If you are set on clear aligners for treatment but can’t afford in-office options, online clear aligners might be the solution that works for you. They’re often at least $1,000 less than traditional aligners but keep in mind that they can only treat mild and moderate cases.
Be encouraged by the fact that you can potentially receive coverage for your braces, Invisalign, or at-home aligner treatment. But remember that there are several factors involved. Plan ahead and do your research on the options and you’ll find a plan that fits your condition, treatment, and priorities.
Frequently Asked Questions
How do I verify insurance coverage?
If you’re going the traditional route (braces or Invisalign), chances are your orthodontist or dentist will do this for you before you sign on for treatment. However, you can call the number on the back of your insurance card and ask to speak to a representative about your coverage limits for orthodontic treatment.
Can I get treatment directly after taking out a new insurance policy?
It’s possible, but most providers will impose a waiting period before they will cover orthodontics.
Why do some insurance policies not cover adult orthodontic treatment?
It’s likely because orthodontics in adults can be more complex, increasing the costs.
Can I convince my provider to cover at-home clear aligners?
It’s possible. More and more providers are offering coverage for remote treatment, so keep checking with your insurance company. Plus, some of these mail-order clear aligner services will help you out. If you decide to go with Byte, for instance, they’ll do all the legwork to help you claim your benefits.
Will my dentist or orthodontist help me lower the cost of treatment?
They might. Some offer special discounts and programs that can lower the cost a bit.
Can I get financing?
Yes, there are medical financing providers that can help you cover your out-of-pocket expenses.
Why is orthodontic care so expensive?
Orthodontics is a complex medical science practiced by highly skilled practitioners with years of additional training beyond dental school. It involves special appliances, high-tech equipment, and comfortable offices. All of this goes into the pricing of services.
Can I bill two insurance providers?
No, double billing insurance companies is illegal, but you can have one company cover what the other does not if the policy allows for this.