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? That’s what we’re here to discuss.
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How Does Dental Insurance Work?
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 plans, 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
As you sift through insurance jargon, you’ll see some recurring terms. Understanding these terms will help you better understand your coverage.
- 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.
What Types of Orthodontic Treatment Might Be Covered?
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 from people under age 19.
Tip: for more information, check out our full guide dedicated to covering the ins and outs of dental insurance coverage for Invisalign.
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 – $6,000. Of course, your bill might fall outside that range for particular 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 for treatment with braces by checking out our guide to covering braces with dental insurance
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, for example, has partnerships with Anthem and Guardian (and others, coming soon); SmileDirectClub partners with UnitedHealthCare, Aetna, and Blue Cross Blue Shield; and Candid partners with Anthem.
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.
We do our best to keep track of insurance coverage details for the most popular online aligner companies in the following series of articles: SmileDirectClub Insurance Coverage, byte Insurance Coverage, Candid Insurance Coverage, AlignerCo Insurance Coverage
Which Insurance Companies Cover Orthodontics?
In a way, all of them. Technically, every insurance provider has 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 choice on 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?
Where to Get Dental Insurance
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 plans 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.
Other Ways to Manage Costs
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: 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 there’s nothing wrong with getting multiple estimates on Invisalign to compare prices. Just make sure that the dentist you choose is in your provider’s network or you might not receive coverage.
Use an HSA or FSA account: These accounts are nice because they allow you to make tax-free contributions that you can use later on health expenses. They’re an option in many employer-sponsored insurance plans. If you have an HSA or FSA, you can use it to pay for your Invisalign treatment.
Consider at-home aligners: If you like the appearance of clear aligners but don’t want to pay Invisalign’s high prices, check out home aligners. They’re a faster and cheaper alternative, but they’re restricted to treating mild and moderate cases of crowding and spacing.
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.