Dental insurance can save you a ton of money on preventive care and basic procedures. But unfortunately, it won’t cover all your dental expenses. Take orthodontics, for example. Some plans cover it; others don’t. Plus, 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 kind of prices to expect.
If you have MetLife, there’s a chance that your plan will partially cover clear aligners or braces. 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’s severity, your dentist or orthodontist’s rates, and the type of treatment you choose.
Invisalign is one of the most well-known and effective forms of orthodontic treatment. It’s also one of the most expensive, with a typical price range of $3,000–$8,000. Since there is no set cost, the only way to know what you will pay is to get a quote from a dentist. Factors that can influence your price include the complexity of your condition, the length of treatment, what Invisalign provider tier your dentist is in, and where you live. Read through our true cost of Invisalign guide for a closer look.
Other In-Office Aligners
Invisalign may have the most recognition but it isn’t the only option for in-office aligner treatment. ClearCorrect has been their top competition since 2006. They have lower lab and aligner fees, so their average treatment price is $3,000–$5,000. SureSmile ranges from $2,000–$6,000 in most cases, and 3M Clarity matches Invisalign’s prices but exceeds its scope of treatment.
At-Home Clear Aligners
If you’re worried about making treatment affordable, at-home aligners could be the solution. Administered remotely, they tend to cost thousands less than in-office treatment, with a typical price range of $1,200–$2,500. Remote aligner providers almost always use flat-rate pricing, meaning you pay the same amount as everyone else no matter how many aligners you need. Just keep in mind that they can only address mild and moderate misalignments.
Byte is our top-ranked at-home aligner provider and comes with a cost of just $1,999 for all-day treatment. If you want to wear your aligners only at night, that price goes up to $2,399 — still significantly more affordable than options like Invisalign. They also have an average treatment plan length of just 4–5 months and guarantee your results for life. Byte handles the insurance claim process from start to finish, too. Check out our guide on insurance coverage with Byte for more info.
Braces are the most iconic form of orthodontic treatment, with that silver metal gleam being what you picture when you think about straightening smiles. They’re pretty pricey, too, with an average cost of $4,000–$6,000. Like aligners, there is a lot that can impact the price you pay. Learn more about that by reading our guide on the true cost of braces.
What Does Dental Insurance Usually Cover?
Dental insurance, like all insurance, is a business. And that means companies are looking to make a profit. When it comes to coverage, they’re most likely to pay for affordable procedures and those that can prevent more problematic and expensive issues from developing. Policies tend to place dental procedures into one of four categories: preventative, basic, major, and cosmetic.
The average dental plan will cover 100% of preventative treatments, like your twice-yearly cleanings. These treatments are affordable and help stop bigger issues from developing, so this level of coverage makes sense from a profit perspective. Many will also cover basic treatments (think fillings and gum disease treatment) at 75–100% of the cost.
Major treatments may or may not be covered, and when they are, the percentage is usually 50% or less. Restorative procedures like crowns and bridges fall into this category. Cosmetic procedures are rarely, if ever, covered. These include veneers, whitening, and tooth shaping.
What About Orthodontics?
So, how do dental policies classify orthodontics: preventative, basic, major, or cosmetic? Well, most policies won’t treat orthodontics as any of those; it receives its own separate coverage.
Within the umbrella of orthodontic coverage, procedures can be classified as necessary or cosmetic. As for how braces and aligners are classified, well, it depends. Some policies always see them as cosmetic unless there is a very significant alignment issue present. Others take a more balanced approach, classing them as necessary as long as they can prevent worsening oral health or general health. So, even if you have orthodontic coverage, don’t assume your treatment will be covered.
Key Terminology to Know
Part of navigating insurance coverage and understanding your financial responsibility is deciphering the jargon. Below are the top financial words and phrases you need to know in order to understand your policy and costs.
- Deductible: This is the set amount you need to pay out of pocket before your insurance benefits kick in. If your deductible is $1,000 and you haven’t paid anything toward it this year, any treatment that costs $1,000 or less would be paid for fully by you.
- Copay: Short for copayment, this refers to a specific amount you pay for covered treatments and can vary between procedures. For example, you might need to pay $50 toward every office visit, even after you’ve met your deductible.
- Coinsurance: In addition to paying a set fee per procedure or visit, you also might need to pay a specific percentage of the cost. Like copays, the amount can change depending on the procedure.
- In-Network vs. Out-of-Network: When a dental provider is partnered with an insurance company, the company considers them an in-network provider. This means a higher percentage of treatment is covered and their office can handle your insurance paperwork. If someone is out-of-network, treatment with them might not be covered or will be covered at a lower percentage. You’ll also be responsible for the paperwork.
How to Get Orthodontic Coverage with MetLife
To get orthodontic coverage from MetLife, you need to enroll in a plan that includes it. Remember: not all dental plans include orthodontic benefits. You have two options for accessing dental coverage with MetLife: get a policy through your employer or take out an individual policy.
Both options have their benefits and drawbacks. With an employer-sponsored plan, insurance premiums are deducted from your wages before your income is taxed, saving you money come April 15th. Additionally, employers will often pay part of your premiums, lowering the cost of insurance.
If you opt for an individual plan, you have more flexibility in your coverage since you can choose whatever works for you — you aren’t limited to the plans offered by your employer. You can also take out an individual policy at any time; with employer-sponsored plans, you have to join in the fall during the open enrollment period, and coverage won’t kick in until the next calendar year. Metlife offers individual TakeAlong plans in most states, but we recommend shopping around as other providers may offer more generous orthodontic benefits in your state.
Save on Orthodontics Without Traditional Insurance
For those without dental insurance or with a plan that doesn't cover orthodontic treatments, DentalPlans may offer an appealing alternative. This service helps connect individuals with dental savings plans, an option that can provide more flexibility than traditional insurance.
These plans, which offer potential savings of up to 25% on orthodontic treatments, are designed to meet the needs of those struggling with high out-of-pocket costs. DentalPlans takes into consideration your unique circumstances, to help identify the most suitable plan for your needs.
MetLife Invisalign Coverage
Some of MetLife’s standard PPO plans don’t include orthodontic benefits, but others do. However, when they do provide coverage, there’s usually a lifetime limit (often somewhere between $1,000 and $3,000). If you have a MetLife TakeAlong plan, you might receive up to 50% coverage, although in some plans, this only applies to patients below age 19. So, even if you receive coverage, it likely 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, SureSmile, and 3M Clarity are similar to Invisalign, they 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. Some of MetLife’s basic PPO plans won’t include these benefits, while others 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 to hope for, 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
Some MetLife plans say that they will cover teledentistry, and the company has a partnership with SmileDirectClub, which makes them an in-network provider. If you don’t choose SmileDirectClub, you or your home aligner company will need to contact MetLife to find out if your plan includes teledentistry benefits for other companies. Some customers on online forums and review sites say they didn’t receive any coverage from MetLife. But the company has various plans, each with different benefits, so you still might get some help.
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 human resources department can 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 are typically classed as out-of-network providers, but some will still handle the insurance paperwork for you. Byte takes over the full insurance process from start to finish, including ongoing communication and appeals to the insurance provider. SmileDirectClub also helps with things like checking coverage and filing claims, but if you need to appeal a decision, you’ll likely be on your own.
If you choose another company, you’ll be on your own. Go to HR for assistance with employer-sponsored plans. For individual plans, you can find the forms you need online or call the number on the back of your insurance card for assistance.
After you file your claim, it can take anywhere from a few weeks to several months for MetLife to process it.
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? There are still ways to make a straighter smile work within your budget.
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can both be used to pay for orthodontic treatment — with certain limitations. Both types of accounts let you save pre-tax money to apply toward qualifying medical and dental expenses. HSAs are open to anyone with a high-deductible health plan while FSAs are tied to your employer.
You might have one of these accounts or both, and if you have both, you can use funds from each to cover the cost of treatment, assuming the treatment you choose is a qualifying expense. They can also be used in conjunction with insurance benefits. The only caveat is that you cannot double-bill, so use your insurance benefits first, then FSA funds (because they expire) for the remaining expenses. If there is still part of the bill left to pay after insurance and FSA funds, use your HSA funds.
But what if you still have expenses left after insurance, FSA, and HSA funds? Or what if you don’t have all — or any — of the above? In that case, financing might help. Most dentists and orthodontists will offer some sort of financing or payment plan option, and if you choose at-home aligners, nearly all companies have financing as well.
Despite what you might hear, you can get coverage for orthodontic treatment through MetLife. Their plans don’t appear to cover orthodontic treatment as often as other insurance providers, and this is especially true for at-home aligners. But if you do receive orthodontic benefits, you might get up to 50% of your braces or Invisalign treatment covered.
It just comes down to your plan’s details and the type of treatment you choose. As you research your options, look up your plan or get in touch with MetLife to discuss 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.
Frequently Asked Questions
Why are dental policies separate from health insurance?
It all comes down to how general medicine and dentistry got started as two different fields. Because they didn’t merge their schools, techniques, or professional associations, everything between the two has always been separate — including insurance.
Is it better to get a policy through an employer or on your own?
This depends on your needs and priorities. If your employer offers a dental policy that authentically meets your coverage needs, it is likely the better choice since it can save you money on taxes and premiums. However, if the coverage level isn’t what you need, you might be better off taking out an individual policy.
What is an open enrollment period?
Open enrollment periods are brief windows of time when people are allowed to enroll in (or modify or cancel) an employer-sponsored insurance plan. These almost always occur in the fall, with coverage going into effect at the start of the following calendar year.
What is teledentistry?
Teledentistry refers to dentistry and orthodontic procedures and services rendered remotely instead of in person. This can be as simple as checking in with your dentist over video chat to things as complex as complete aligner treatment from home.
What makes some insurance companies hesitant to cover at-home aligners?
All orthodontic treatment comes with risks, and it’s easier to catch certain problems when patients are seen in person. The issue is that most of these risks are smaller with at-home aligners because they don’t make big tooth shifts. As more research emerges, more and more companies are opening up to covering remote aligners.
If I have orthodontics coverage, how much should I expect to pay out of pocket?
This depends on many factors. Variables that might impact your cost include:
- The treatment you select
- The dentist you work with
- The complexity of your case
- The percentage of treatment your policy covers
- If you’ve met your deductible
- What your copay and coinsurance are
- How many office visits you’ll need
Even if MetLife doesn’t cover at-home aligners, could they be the better choice?
They might be. It’s a good idea to see how much you will need to pay out of pocket with traditional orthodontics and compare that to the cost of at-home aligners. If the remote option is more affordable and budget is your top factor, at-home aligners could be the way to go.
If my policy doesn’t include orthodontic coverage, can I add it on as a rider?
It is possible, but not always an option. Not all companies allow this, and if your plan is employer-sponsored, they might exclude orthodontic coverage.
What are reasons adults are denied orthodontic coverage?
The number-one reason for adults to be denied orthodontic coverage is their age — many policies only cover children and teens. The second is having already exhausted their lifetime benefits.
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