Does Guardian Cover Clear Aligners & Braces?

Straighter teeth rarely come cheap. If you’re considering braces or clear aligner treatment, their steep prices can be intimidating, and you might be looking for help. Good news: some insurance plans provide coverage for orthodontic treatment. But it depends entirely on the provider and plan. It’s wise to examine the details of your insurance policy before selecting a treatment so you’ll know how much you might have to pay.

If you have Guardian, there’s a chance that your clear aligner or braces will be covered, but it depends upon your particular plan and the form of treatment you select. Before you dive in, read this guide for an in-depth look at Guardian’s coverage and instructions on how you can use it.

Average Costs Before Insurance

In most cases, there is no set fee for orthodontic treatment, save for at-home aligner companies with flat-rate pricing. Even then, discounts, flash sales, and nighttime-only treatment can change the price. Several factors can influence how much you’ll pay for traditional options, including the type of treatment, your orthodontist’s rates, your location, and the severity of your condition. Below are the average prices for Invisalign, braces, and at-home aligners.

Invisalign

Most Invisalign patients end up with a bill somewhere between $3,000 and $8,000. That’s a wide price range, which is typical with in-office treatments. Even though Invisalign has set costs for things like aligners and lab fees, there are a lot of variables at play, including the complexity of your case, any discounts your doctor gets, and even where you live. Read through our true cost of Invisalign guide for a closer look.

Other In-Office Clear Aligners

Invisalign took clear aligners mainstream, and they remain the only household name. However, they aren’t the only option available to you. ClearCorrect launched back in 2006 and made a name for themselves with excellent results and lower prices — $3,000–$5,000 on average. SureSmile is more customizable than other brands and averages $2,000–$6,000. 3M Clarity isn’t more affordable than Invisalign but has a wider scope of treatment, so it’s worth considering, too.

At-Home Clear Aligners

When it comes to affordability, it’s rare for in-office treatment to beat at-home clear aligners. With an average price range of $1,200–$2,500, they are often thousands cheaper than traditional treatments. Nearly all at-home aligner providers use flat-rate pricing, meaning every customer pays the same price no matter how many aligners they need.

SmileDirectClub is $2,050, while AlignerCo is $1,145. Byte, our top-ranked provider, is $1,999 for all-day treatment. While not the lowest price, it offers a lot of value, speedy treatment plans, and a lifetime smile guarantee. On top of this, they handle the insurance claims process from start to finish. Check out our guide on insurance coverage with Byte for more info.

Braces

Braces can be one of the more affordable in-office options or the most expensive. It all depends on the type of braces you get and the complexity of your case. Most people will spend $4,000–$6,000 on treatment, but certain types of braces can cost more than $10,000. See our guide on the true cost of braces.

What Does Dental Insurance Usually Cover?

There is a lot of variation between dental insurance providers and even between policies from the same provider. While we can cover that is typically true of dental insurance, it’s essential that you don’t base your understanding of your policy on generalities. Read your paperwork, clarify with your insurance company, and make certain you know what your insurance does and does not cover.

Most companies will have four classifications for treatments: preventative, basic, major, and cosmetic. For each class, they offer different coverage terms.

Preventative treatments (routine cleanings and care) are important to both patients and insurance companies. Since they help stop major issues from developing, they preserve the health of the patient and minimize the expenses for the insurer. As a result, these treatments are often covered in full, or at least at a very high percentage. Basic treatments (fillings, root canals) are often seen in the same way, with full or high coverage.

Major treatments are less likely to be covered, and when they are, the coverage is lower — often 50% or less. This includes things like crowns and bridges. Cosmetic treatments are rarely, if ever, covered, so if you want whitening or veneers, the cost will be out of pocket.

How Are Orthodontic Treatments Classed?

Orthodontics exists in something of a gray area. Treatment can be medical — some misalignments harm not just the teeth but the digestive system due to poor chew function. It can also be cosmetic when correcting things like small gaps that aren’t causing harm.

Assuming your policy includes orthodontic coverage (not all do) and they extend this coverage to adults (many restrict coverage to children and teens), whether or not your insurer will help pay will depend on the nature of your misalignment.

Key Terminology to Know

Part of deciphering your policy is understanding the jargon. There are four phrases that you’ll need to know to better grasp how much you’ll need to pay for orthodontic treatment.

• Deductible: Unless you have a very high premium policy, you’ll have an annual deductible to meet. This is a set amount of money you’ll need to pay out of pocket each year before insurance benefits kick in.
• Copay: With most policies, you need to pay a fee for every covered office visit and procedure. The price can vary or be the same across the board.
• Coinsurance: Some policies may have coinsurance instead of copay, or a policy might have both. With coinsurance, you need to pay a set percentage of the cost of treatment. The exact percentage can vary between procedures.
• In-Network vs Out-of-Network: Dental providers can partner directly with insurance companies. When they do, they handle the insurance claims process and treatments from them are covered at a higher percentage. An out-of-network provider is a dentist without a partnership with your insurance company. You’ll need to handle the claims and treatment will be covered at a lower percentage, if it is covered at all.

How to Get Orthodontic Coverage with Guardian

You don’t need to purchase orthodontic coverage separate from your dental insurance — it’s either included in a Guardian dental plan or it’s not. You can get a Guardian dental plan with orthodontic coverage in one of two ways: through your employer or on the insurance marketplace.

Employer-sponsored plans come with the advantage of reducing your tax burden (premiums are paid using pre-tax income) and lowering what you pay in premiums (many employers will pay towards them). The downsides with these plans are that you cannot get a plan until open enrollment comes around and you are limited to the plans your employer offers — which might not fit your needs.

If an employer-sponsored plan isn’t right for you, you can choose to take out an individual plan purchased on the insurance marketplace. Guardian offers individual plans in most states, but we recommend shopping around as other providers may offer more generous orthodontic benefits in your state.

Guardian Invisalign Coverage

Many of Guardian’s basic dental HMO or PPO plans will not cover orthodontic treatment, while their top-tier plans will — but usually only for patients up to age 19. Many plans also include a lifetime coverage limit or a waiting period. For people who live in New York, Florida, Illinois, or Texas, the Guardian Direct Managed DentalGuard DHMO plan will cover adult orthodontics with a fixed copayment of $2,800.

Most times, you’ll need to use an in-network dentist or orthodontist to receive your coverage. Out-of-network providers aren’t often covered.

As in-office treatments, ClearCorrect, SureSmile, and 3M Clarity are in a similar boat. If your plan includes orthodontic benefits without an age limit, there’s a good chance you’ll be partially covered. If not, you’ll likely have to pay the entire amount.

Guardian Braces Coverage

Guardian’s braces coverage is very similar to their Invisalign coverage. Basic dental plans don’t usually cover them while more comprehensive (and more expensive) ones might provide coverage for patients under age 19. Plans will rarely ever cover the entire cost, and will often have limits on age or lifetime spending. If you live in New York, Florida, Illinois, or Texas and have a Direct Managed DentalGuard DHMO plan, it may help pay for your braces. Familiarize yourself with your plan’s details so that you’re not surprised by a coverage restriction.

Lingual braces and clear braces are also often covered by orthodontic benefits 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 Guardian to find out.

Remember that you’ll need to get treatment from a dentist or orthodontist in Guardian’s network to receive the full amount for your coverage.

Guardian At-Home Clear Aligners Coverage

Guardian has a standing partnership with Byte (our favorite at-home aligner company) to provide in-network coverage for members with orthodontic benefits. They provide a $200 discount on aligner treatment and a $50 discount on whitening. How much they will cover after that depends on your specific plan. See this page on Byte’s website for more information. If you’re going with Byte, they will navigate the entire insurance process for you, so just get in touch with their customer service team with any questions or concerns.

Guardian doesn’t have other partnerships with other at-home aligner companies, but their relationship with Byte indicates they might be open to covering other at-home aligner treatments as well. The only way to know for sure is to check with your provider directly. SmileDirectClub will check for you, although they won’t file a claim for you and handle all insurance communication like Byte does.

How to File a Claim

With in-office treatments, if you go with an in-network provider, you don’t need to worry about how to file a claim — your dentist’s or orthodontist’s office will handle the full process, including any appeals that are needed. If you choose an at-home treatment or work with an out-of-network provider, things get more complicated.

Some home aligner companies offer insurance assistance. SmileDirectClub will check coverage for your while Byte will handle the entire process from start to finish, including appeals. Most other companies won’t offer any assistance, though it doesn’t hurt to ask.

If you’ve never filed a claim before, Guardian has some resources that can help. Visit their “Submit a Claim” page or this FAQ page that specifically addresses dental PPO claims for instructions. Once you file your claim, a response can take a few weeks or several months.

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? Or the coverage they offer isn’t enough to make orthodontics fit into your budget?

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use either to pay for your treatment so long as it is a covered expense. Prioritize using your FSA funds first since they expire each year while HSA funds roll over. You can use insurance first, then FSA funds to cover the remaining balance — and if that isn’t enough, you can apply your HSA funds.

If you don’t have these accounts or the funds don’t cover the full balance, you can look into financing and payment plans to break up the cost into more manageable chunks. This might increase the overall cost but make it easier to fit into your budget.

Conclusion

There are two important things to remember here. First, you can get coverage for your braces or clear aligner treatment if you have Guardian dental insurance. Second, that coverage depends on your specific plan. Even though Guardian doesn’t include adult orthodontic benefits in many of their plans, the plans that offer it seem somewhat flexible, especially considering their partnership with Byte to cover home aligner treatment. If you’re considering Byte, their insurance team will handle your communications, paperwork, and claims, so reach out to get started.

Above all else, make sure you know the details of your plan so you’ll have a good idea of your coverage details, limits, and potential expenses.