Does Guardian Cover Clear Aligners & Braces?

Straighter teeth don’t often come cheap. If you’re considering braces or clear aligner treatment, you might be intimidated by their steep prices, 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 plan 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 treatment will be covered, but this will depend upon your particular plan and the form of treatment you select. Before you dive into treatment, read this guide for an in-depth look at Guardian’s coverage and instructions on how you can use it.

Average Costs Before Insurance

We mentioned that orthodontic treatment is expensive. But what kind of prices should you expect? Several factors can influence your final price, including the type of treatment, your orthodontist’s rates, your location, and the severity of your condition. But here are the average prices for Invisalign, braces, and at-home aligners.

Invisalign

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.

Braces

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 Guardian

Orthodontic coverage isn’t something you need to buy separately — it’s simply included in certain Guardian plans. There are two ways to get enrolled in a suitable Guardian dental plan: through your employer, or by purchasing an individual plan.

About half of all adults in the US receive dental insurance through their employer (or that of their spouse). There are a couple of advantages to enrolling in dental insurance through an employer plan. For one thing, insurance premiums get deducted directly from your wages before tax, reducing what you owe in taxes. For another, employers often contribute toward the cost of their plans, which results in lower premiums.

However, there are also some important drawbacks with employer-sponsored dental plans. First, you’re limited to the plan options offered by your employer. This can be especially problematic if you’re interested in braces or clear aligners, as many dental insurance plans do not cover orthodontics, or offer very limited coverage. Second, employer-sponsored dental plans are often bundled together with health plans, so you may need to wait for an “open enrollment” period to modify your plan. Lastly, many companies simply don’t offer dental insurance at all!

Fortunately, even if you receive health and/or dental coverage through your employer, you can always invest in an individual plan that covers orthodontics, too. And unlike buying standard health insurance, you don’t have to wait for an open enrollment period to purchase an individual dental/orthodontics plan — you can enroll at any time of the year. 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 a decent number of their full coverage plans will, and that includes Invisalign. But even if your plan provides orthodontic benefits, you’ll need to carefully review the details, because it might have an age limit (up to age 19), a lifetime coverage limit, or a waiting period.

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 and Six Month Smiles 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. Plans will rarely ever cover the entire cost, and will often have limits on age or lifetime spending. For example, Guardian’s website says that their “Managed DentalGuard DHMO plans in New York, Florida, Illinois, and Texas cover $2,800 towards braces for adults 19 and over with no waiting period.” 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. How much they will cover 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.

What about other home aligner companies? Guardian doesn’t have other partnerships, but their relationship with byte indicates that 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. Candid and SmileDirectClub will check for you to determine if you’ll receive coverage, although they won’t file a claim for you and handle all insurance communication like byte does.

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 Guardian. 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.

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.

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

What if you’re ready to get started with braces or aligners, but your current insurance plan doesn’t cover the treatment you want?

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 MetLife, 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).

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. Guardian actually appears more flexible with their orthodontic coverage than some of their competitors, 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.