Dental insurance can save you a ton of money when it comes to preventive care and basic procedures. But unfortunately, it won’t cover all of your dental expenses. Take orthodontics, for example. Some plans cover them, but others don’t. On top of that, braces and clear aligners aren’t cheap, so coverage can be incredibly helpful. Understanding the details of your specific plan will help you know what to expect for orthodontic prices.
If you have MetLife, there’s a chance that your clear aligner or braces treatment will be partially covered. Before you dive into treatment, read this guide for an in-depth look at MetLife’s coverage and instructions on how you can use it.
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Average Costs Before Insurance
We mentioned that orthodontic treatment is expensive, but it can vary significantly based on your condition severity, your dentist or orthodontist’s rates, and the type of treatment you choose.
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.
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 MetLife
MetLife doesn’t have orthodontic benefits as an “add-on.” Their plans either include orthodontia or they don’t. If your plan doesn’t include orthodontia and you want to enroll in a different one, you’ll typically need to wait for an open enrollment period, unless you’ve experienced a qualifying life event, which most commonly include:
- Changes in household (marriage, divorce, birth, death)
- Changes in residence
- Loss of health coverage
- Becoming a U.S. citizen
Like many others, you might receive dental benefits through your employer. When providing health and dental insurance, employers select certain plans to sponsor, and yours may or may not have chosen ones with orthodontic benefits. If you would like to receive orthodontic coverage, but your employer doesn’t offer a plan that includes it, you can always reach out to Human Resources to see if they might consider changing or adding plans.
MetLife Invisalign Coverage
Most of MetLife’s standard PPO plans don’t include orthodontic benefits, but some of their more expensive comprehensive PPO plans do. However, when they do provide coverage, there’s usually a lifetime limit (often somewhere between $1,000 and $3,000). Or, if you have a MetLife TakeAlong plan, you can receive up to 50% coverage, although in some plans, this only applies to patients below age 19. So, even when you do receive coverage, it won’t be for your entire bill. Of course, it all depends on your specific plan, so review the benefits carefully before enrolling.
Since ClearCorrect is a similar treatment to Invisalign, it might also be partially covered, depending on your plan. Six Month Smiles typically treats milder cases, so it’s more often considered a cosmetic procedure, but not always! You’ll have to check with the company and your dentist to find out.
MetLife Braces Coverage
MetLife will also cover braces treatment, but only on certain plans. If a plan offers orthodontic benefits, it will cover part of your braces treatment. Typically, MetLife’s basic PPO plans won’t include these benefits, while the more expensive ones will. As we mentioned in the Invisalign section above, MetLife’s orthodontic benefits often come with a lifetime limit or an age limit. Best-case scenario, you’ll get around 50% of your treatment covered.
Lingual braces and clear braces fall into the same boat 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 MetLife to find out.
Remember that you’ll need to get treatment from a dentist or orthodontist in MetLife’s network to receive the full amount for your coverage.
MetLife At-Home Clear Aligners Coverage
MetLife doesn’t specifically state whether or not their plans cover at-home aligner services, although some do say that they will cover teledentistry. You or your home aligner company will need to check with them to find out if your plan includes teledentistry benefits and, if so, whether those benefits include at-home aligner treatment. Customers on online forums and review sites report that they didn’t receive any coverage from their MetLife plans. But the company has various plans, each with different benefits, so you still might get some help.
Certain insurance providers have partnerships with at-home aligner companies that bring them in-network, but as of right now, it appears that MetLife does not. That doesn’t mean, however, that they’ll never cover your at-home treatment. You or your home aligner company will need to check with the insurer.
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 MetLife. 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.
You can file and monitor claims through MetLife’s Claim Center after logging into your account. Find all the info you need on this page, which outlines each type of insurance claim.
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 company 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
You’ve checked with MetLife and your plan doesn’t include orthodontic benefits. Now what? Unfortunately, there’s no option to simply tack orthodontia onto your existing plan. You can potentially change your plan, but you would need to wait for an open or special enrollment period. Plus, some plans have a waiting period before you can use your new benefits. If you’re trying to start treatment ASAP, this might not be ideal. On the other hand, the money you save might be worth the wait.
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 Delta, 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).
Despite what you might hear, you can get coverage for orthodontic treatment through MetLife. Their plans don’t appear to cover orthodontic treatment quite as often as other insurance providers, and this is especially true for at-home aligners. But if you do receive orthodontic benefits, you may get up to 50% of your braces or Invisalign treatment covered, which is comparable to other insurers.
It just comes down to the particulars of your plan and the type of treatment you choose. As you research your options, look up your plan or get in touch with MetLife to learn the details of your specific benefits. It might influence your final treatment decision. After you have a thorough understanding of your insurance, you’ll have a much better idea of what your treatment might cost.