Does Dental Insurance Cover Invisalign for Adults?

Invisalign is an investment in your smile, one that can last forever. As a result, it’s fairly expensive. Between all the office visits, dentist’s fees, and manufacturing costs, it can cost a few thousand dollars, which you might not be ready to pay. Fortunately, your dental insurance might be able to help.

Dental insurance plans sometimes cover Invisalign treatment, although it depends on your specific provider and plan. This guide will help you navigate your insurance details and know what to expect.

Does Insurance Cover Invisalign?

The short answer: Maybe. According to Invisalign, “many dental insurance plans cover Invisalign treatment the same way they cover braces,” but you’ll need to look for your plan’s orthodontic treatment policies.

Orthodontic benefits sometimes fall under dental insurance, while other times they might fall under health insurance. If your plan includes them, there’s a good chance your insurance will cover Invisalign. But if you don’t have orthodontic benefits, you’re probably out of luck.

The point is, every plan is different, and the only way to know for sure is to review your plan’s details or contact your provider. If you receive coverage, it might be for a specific amount or percentage of your total treatment cost.

Average Cost of Invisalign (Before Insurance)

If you’ve already gotten an estimate on Invisalign treatment, you know how expensive it can be. If not, you can expect to pay somewhere between $3,000 and $8,000. The exact price depends on your condition, your dentist or orthodontist’s fees, your location, and more.

It can even fall outside that range if you have a particularly easy or complicated condition. For example, a minor case of spacing might take less time to correct and, therefore, less money. While a severe case of overbite and crowding might come with a higher financial and time commitment.

Average Cost of Invisalign After Insurance

Nationwide orthodontic expenditures nearly doubled between 1996 and 2016, and out-of-pocket expenses were the largest contributor. That means more people have started seeking teeth-straightening treatments, but many end up paying at least some of the cost on their own.

It’s rare for an insurance plan to cover 100% of Invisalign treatment. If you have orthodontic benefits, it’s more likely that they’ll cover 25%–50% of the total price. However, some plans also have a lifetime maximum they’ll pay for orthodontics. Once you hit that cap, you’ll pay the rest out of pocket, regardless of the percentage your plan covers.

For example:

Scenario 1: Your insurance will cover 50% of your $7,000 treatment, but doesn’t have a lifetime maximum. You’ll end up paying $3,500 out of pocket and receive $3,500 from your insurance provider.

Scenario 2: Your insurance will cover 40% of your Invisalign, which costs $6,250, but your plan has a $2,000 lifetime maximum. If you haven’t used insurance for any other orthodontic treatments, you’ll receive $2,000 and pay $4,250 out of pocket.

How Do Orthodontic Benefits Work?

It’s natural to think that every dental insurance plan includes orthodontia, but this isn’t always true. Some plans have orthodontic benefits and some don’t. And even the plans that include orthodontia can come with restrictions.

You can enroll in a dental insurance plan either through your employer or on your own. Once you have insurance, you can use it for whichever treatments it includes (unless there’s a waiting period, but more on that later). Often, orthodontic benefits will cover a certain percentage of your orthodontic treatment or pay up to a certain amount.

Factors That Affect Invisalign Insurance Coverage

Many times, orthodontic benefits cover Invisalign, but it depends on the plan. Typically, the most basic plans won’t include any orthodontic coverage, while the more comprehensive, more expensive plans will. Every insurance company above has a plan (or multiple plans) that might cover braces or clear aligners.

This coverage also can extend to other in-office aligner treatments like ClearCorrect and Six Month Smiles. But to be sure, you should double-check with your dentist/orthodontist and insurance provider.

Amount Covered

Many plans with orthodontic benefits will only cover part of your treatment. Sometimes they will cover up to 50% of your treatment, and other times there will be a lifetime coverage limit. There are also some restrictions that you should keep in mind as you shop for dental insurance and enroll in a plan.

In-Network vs. Out-of-Network

Each dental plan has a network of dentists that are approved to file coverage claims. If you choose an in-network dentist or orthodontist, you will receive coverage for the treatments outlined in the plan. If you don’t like any of the in-network dentists, you can always go to an out-of-network one. You just won’t get the same level of coverage.

Most insurance providers have fairly sizable networks, especially if you have a PPO plan, so you should be able to find a good fit. However, if you’re adamant about an out-of-network dentist, you may have to find other ways to manage the costs.

Age Limits

This is one of the most common restrictions on orthodontic benefits. In most cases, plans with age limits will cover orthodontic treatment for people up to age 19, but not for adults. You should always check for an age limit as you examine your insurance plan.

Lifetime Maximum

Many plans will also have a maximum amount that they’ll cover for orthodontic treatment over your lifetime. These limits are often somewhere between $1,000 and $3,000, but could be more or less, depending on your plan.

Waiting Periods

Additionally, some plans may have a waiting period before you can use their benefits. These waiting periods can be anywhere between a few months and a full year. So, if you enroll in a plan solely so that you can get Invisalign, be conscious of any potential waiting periods, or you might have to hold off on your treatment for a few months.

How to Get Orthodontic Benefits

There is just one way to get orthodontic benefits — enroll in an insurance plan that includes them. And there are two ways to accomplish this: either purchase an individual plan on the insurance marketplace or access a plan through your or your spouse’s employer.

Both options can be excellent ways of accessing the care you need, but employer-sponsored plans come with some distinct advantages. First, your company might pay part of your premiums, bringing down the financial burden of having dental coverage. Second, the money you pay toward your premiums is taken from your wages before taxes, meaning you owe less in income tax come April.

Of course, no option is perfect, and employer-sponsored plans have their drawbacks. The biggest is that you’re limited to the plans your company offers — assuming they have any dental policies available. Then there is the issue of open enrollment — the period each year when you can enroll in (or modify or cancel) employer-sponsored insurance policies. This usually rolls around in the fall, with policies and changes not going into effect until January 1st of the next year. That can mean a pretty significant wait for the coverage you need.

If your employer doesn’t offer any dental plans or the ones they have aren’t a good fit for you, there are hundreds of options on the insurance marketplace. It’s just a matter of looking at the terms and selecting the best plan for your needs.

Other Ways to Save on Orthodontic Treatment

What if you already have a plan and it doesn’t include adult orthodontic benefits? Or maybe it does but the out-of-pocket costs are still too high. No need to worry; you still have ways to make treatment easier on your budget.

Enroll in a Dental Discount Plan: Some insurance companies offer coverage alternatives like discount dental plans. These are subscription services; you pay monthly or annually and get discounts on specific procedures from designated dentists. Look for one that extends discounts to orthodontic procedures.

Shop Around: In-office treatments don’t have set prices, meaning different dentists and orthodontists can offer them at varying price points. Get estimates from different doctors and go with the one offering the right price — just make sure they are in-network with your insurance if you want to use that coverage.

Use an HSA or FSA: Both of these accounts let you save pre-tax income and then apply those funds to qualifying medical expenses. In most cases, they can be used for orthodontics if your case isn’t cosmetic. Verify with your account administrator before using funds for Invisalign.

For more info, check out our guides to using an HSA or FSA for Invisalign.

Consider Online Clear Aligners: If you know you want clear aligners but can’t make Invisalign work for your budget, at-home clear aligners offer a more affordable alternative in most cases. And if you choose Byte, you’ll even get assistance with filing insurance claims.

Learn more in our review of the 5 best online clear aligner services.

Final Thoughts

Even though Invisalign is expensive, be encouraged by the fact that you might receive some assistance from your dental insurance, depending on your specific plan. Be sure to consult your dentist or orthodontist and talk to your employer or insurance provider about your plan’s details before jumping into treatment.