Does United Concordia Cover Clear Aligners & Braces?

If you’ve been comparing different orthodontic treatments, you know they aren’t exactly cheap. Moving teeth is an expensive business that leaves most patients looking for help. Insurance can contribute to many dental treatments, but orthodontia is different. It’s not always covered, especially when the treatment is considered cosmetic. But that doesn’t mean you’re out of luck — your United Concordia dental insurance might provide partial coverage. It just depends on your plan.

Some United Concordia plans cover orthodontic treatments and others don’t. But there are a lot of details to consider, like in-network dentists, the type of treatment, and potential coverage limits. Before committing to treatment, read this guide, which provides some foundational information about United Concordia’s plans, procedures, and orthodontic benefits.

United Concordia Invisalign Coverage

Looking into Invisalign? Some of United Concordia’s plans will cover it, but you have to look carefully at the fine print. If you have one of their Flex or Preferred PPO plans, you probably have some type of orthodontic benefits, often up to 50% coverage. And in some cases, you can add adult orthodontics as a rider for group plans covering 51 or more people. So if you have insurance through your employer, they need to have enough beneficiaries enrolled to cover adult treatment — and even then, it’s only optional. Speak with your employer’s human resources office to find out the details of your coverage.

Many of Concordia’s PPO plans include orthodontic insurance only as an option, so if your employer doesn’t choose to include it, you won’t receive it. If you go with the company’s Plus DHMO plan, you likely won’t receive any orthodontic benefits.

As in-office treatments, ClearCorrect, SureSmile, and 3M Clarity are in a similar boat, although you’ll want to check with United Concordia to be sure.

United Concordia Braces Coverage

Like Invisalign, braces are often covered by the orthodontic benefits in some of United Concordia’s Flex and Preferred PPO plans. Their Plus DHMO plans don’t typically offer the same orthodontic coverage. Remember that just because you see “orthodontic” in your plan’s schedule of benefits doesn’t mean your treatment will be covered. Depending on what your employer offers, there might be age limits or lifetime limits on your coverage.

Lingual braces and clear braces receive similar coverage 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 United Concordia to find out.

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

United Concordia At-Home Clear Aligners Coverage

United Concordia doesn’t explicitly state whether they will cover at-home aligners. And they don’t currently have any partnerships with at-home aligner companies like Byte or SmileDirectClub. This doesn’t necessarily mean that they’ll refuse to cover home aligner treatment, but if they do provide coverage, they’re not open about it.

In some online forums and reviews, home aligner customers have stated that United Concordia insurance didn’t cover their treatment. However, we don’t know the details of their plans, and other plans might provide coverage.

If you have a United Concordia dental plan and you’re interested in at-home aligners, check with the aligner company and/or an insurance representative to discuss your plan’s details. Byte will handle all of your insurance communication, claims, and paperwork for you. SmileDirectClub will check for you, although they won’t file a claim for you and handle all insurance communication like Byte does.

Average Costs Before Insurance

So, orthodontic treatment is pricey, but you’re probably looking for a specific idea of what you might pay. It’s hard to pin down prices for braces or clear aligners because they depend on things like your condition’s severity, your dentist/orthodontist, your location, and the type of treatment. But we’ve got some averages for you, so you can get a general sense of what to expect.

Invisalign

With in-office treatments like Invisalign, you’ll rarely encounter flat-rate pricing. Instead, your cost is determined by how many aligners you need, the attachments required, and the number of office visits your treatment requires. Most people end up paying somewhere between $3,000–$8,000. Read through our true cost of Invisalign guide for a closer look at variables impacting price.

Other In-Office Aligners

Invisalign took clear aligner treatment mainstream, but while it’s the only household name in the game, it isn’t your only option. ClearCorrect was their first major competitor, launching in 2006. They have lower lab fees, so in many cases, treatment is slightly cheaper — usually in the $3,000–$5,000 range. SureSmile is another alternative, offering more customization options and a typical price range of $2,000–$6,000. Then there is 3M Clarity, which has the same price range as Invisalign but offers powerful aligners and a wide scope of treatment.

At-Home Clear Aligners

Invisalign and other in-office aligners require office visits — at least one to kick off treatment and one to wrap it up if opting for hybrid treatment (when progress is monitored remotely) or visits every 4–8 weeks when using a traditional model. At-home aligners take office visits out of the equation.

Eliminating office visits cuts out a lot of the fees that usually come with orthodontic treatment. As a result, at-home aligners are typically thousands less than their in-office counterparts — $1,200–$2,500 on average. Unlike in-office options, these companies tend to utilize flat-rate pricing — SmileDirectClub is always $2,250, while AlignerCo is $995.

Our top-ranked provider is Byte. They have two systems: Byte All-Day and Byte At-Night. Their all-day aligners are $1,999 and their nighttime option is $2,399. They aren’t the most affordable but represent a great value, including multiple items in their treatment bundle, backing results with a lifetime guarantee, and claiming average treatment plan lengths of just 4–5 months.

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 lot easier. Check out our guide on insurance coverage with Byte for more info.

Braces

Braces are the most widely known orthodontic treatment — and depending on the type, can also be one of the most expensive. Simple metal braces can cost as little as $4,000, while options like lingual and self-ligating braces can be more than $10,000. And like other in-office treatments, your costs will vary based on numerous factors (see our guide on the true cost of braces).

What Does Dental Insurance Usually Cover?

While you can talk about insurance coverage in generalities, never assume something to be true for your policy just because it is true for others. Coverage varies not just between companies, but between contracts.

Most likely, your provider classifies dental procedures into four categories: preventive, basic, major, and cosmetic. Preventive treatments (think cleanings) are almost always covered at a high percentage — 100% is normal. That’s because paying for them in full can save the insurance company money later down the road by warding off issues that require more expensive fixes. Basic procedures (fillings, root canals) are typically treated the same.

Major treatments (crowns, bridges) are rarely covered in full. Most policies will pay 50% or less of the cost. Plans rarely cover cosmetic treatments unless your dentist can argue that they are also restorative, so expect to cover the full cost of whitening, tooth shaping, veneers, and similar procedures.

What About Orthodontics?

Based on the above, you might assume that classifying treatments is pretty cut and dry — either it’s necessary to improve your health or it’s simply cosmetic. But orthodontics can be either. Most braces or clear aligner treatments are necessary for your oral health, although they’re occasionally considered cosmetic. So while they’re often covered, that’s not always the case.

How an insurance provider classifies orthodontic treatment will depend on your unique case. But even if your case is considered major treatment, you might not receive coverage. Dental insurance often has a lifetime coverage limit — either per person or per policy. If this has already been met, they won’t help pay for braces or aligners. Additionally, many providers only cover orthodontics in children and teens, leaving adult patients to pay for treatment themselves.

Key Terminology to Know

Before you can decipher your dental policy, you need to know some key jargon. While there are a lot of insurance-specific terms you’ll encounter, the four below are the most important to know.

• Deductible: This is the dollar amount you must pay for treatment before your insurance company will step in to help cover the tab. For example, if your treatment is $500 but your deductible is $1,000 and you haven’t paid toward it yet, you will need to foot the full bill.
• Copay: Even after you meet your deductible, most insurance companies will have you pay toward the cost of every treatment or consultation. This is your copay — short for copayment. The amount can be stable across the board or vary by procedure.
• Coinsurance: Sometimes, policies have coinsurance instead of a copay — and there are those policies that have both. Coinsurance is different in that rather than a set dollar amount paid, it’s a set percentage of the cost of the procedure.
• In-Network vs. Out-of-Network: When a dentist or orthodontist partners with an insurance company, they are considered in-network. If they don’t, they are out-of-network. In-network providers are covered at a higher rate and handle the insurance paperwork for you. Out-of-network providers are covered at a lower rate or not at all and require you to complete the insurance paperwork.

How to Get Orthodontic Coverage with United Concordia

You don’t need to purchase orthodontic coverage on its own; it’s either built into your United Concordia dental policy or it’s not. You have two options for getting United Concordia dental coverage: through an employer or purchasing on the insurance marketplace.

Most people with dental insurance get their policies through an employer — either their own, their parent’s, or their spouse’s. Employer-sponsored dental plans have certain advantages over those purchased on the marketplace. First, premiums are paid from your wages before taxes, reducing your bill come April 15th. Second, employers will often pay toward your premiums, making insurance coverage more accessible.

Employer-sponsored dental plans also have drawbacks. The biggest is that you are limited to the plan options they choose to offer. If none of their policies include orthodontic coverage, you’ll be out of luck. Another issue is that you’ll need to wait for open enrollment to come around to take out coverage. This is a period that comes around once a year — usually in the fall — during which you can take out, modify, or cancel an insurance plan, with coverage or changes taking effect in the next calendar year.

If an employer-sponsored plan isn’t the right option for you, the alternative is to find an individual policy on the insurance marketplace. With this option, you can shop around to find the policy that best meets your unique needs and you don’t need to wait for a specific period to enroll. Just keep in mind that it won’t save you money on taxes and you will be responsible for the full cost of your premiums. United Concordia offers individual plans in most states, but we recommend shopping around as other providers may offer more generous orthodontic benefits.

How to File a Claim

If you get an in-office treatment from an in-network provider, you don’t need to worry about how to file a claim; your dentist or orthodontist will handle this on your behalf. With out-of-network providers, you will likely need to file your claim on your own. If you have an employer-sponsored plan, your HR team might be able to help.

Most people have never filed a dental claim on their own before, but if you need to, United Concordia has resources that can help. Their online Help Center has information on filing claims, and their My Benefits page has downloadable claim documents.

Some at-home aligner companies will also help with the claims process. Byte takes over the entire process from start to finish, including filing appeals. SmileDirectClub helps verify coverage and file claims in most cases. Other companies leave the process up to you. You’ll still need some information from them, though, so contact them once you download your claim form.

Fill out forms carefully and double-check them; even one small error can get your claim denied. Expect processing to take at least a few weeks, and up to several months.

Other Options if You’re Not Covered

United Concordia’s orthodontic benefits aren’t something you can add on after the fact. They’re either included in your dental insurance plan or they’re not. If your current plan doesn’t cover orthodontia, you’ll need to either enroll in a supplemental plan from another company or make a switch — although you can typically only change plans during open enrollment or if you have a qualifying life event.

United Concordia’s iDental Discount Program can also help reduce the cost of your treatment. It’s not an insurance plan, but it can still save you money. If you enroll, you’ll pay an annual fee for access to a network of dentists who offer reduced rates on certain treatments, including orthodontics.

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can put those funds towards your treatment costs — in most cases, at least. These accounts allow you to put away income before taxes and use that money for qualifying medical and dental expenses. Even if you received partial coverage for your orthodontic treatment from United Concordia, you might be able to use HSA or FSA funds to pay the remaining balance, assuming your treatment wasn’t just cosmetic.

If you don’t have these accounts or you still have a balance that is more than you can afford outright, financing is another option to consider. Most at-home aligner companies offer their own plans, while in-office treatments can be financed through third-party companies or your provider’s office. Just keep in mind that these plans usually charge interest and require a credit check.

Final Thoughts

United Concordia can be a good insurance company for orthodontic coverage, but it depends on the plans your employer offers. And if you’re interested in at-home aligner treatment, you might not have great luck since United Concordia doesn’t have the same relationship with home aligner companies that other insurance providers do. But you might still receive coverage, and United Concordia’s iDental Discount Program can help you find great deals on your treatment.

All this information might seem complicated, but your provider can supply a lot of helpful information on your plan if you reach out. And home aligner companies, specifically Byte, will also handle communications with your insurer to help you take advantage of your benefits.