A quick look at your braces or clear aligners bill might send you shuffling through your insurance paperwork, hoping that you’re covered. And if you have UnitedHealthcare, you might be. But it depends on the particulars of your specific plan. Trying to estimate your bottom line costs can seem like hitting a moving target, but understanding your plan’s details and benefits can go a long way.
Your UnitedHealthcare plan could significantly reduce your costs of braces, Invisalign, or even home aligners. Before you dive into treatment, read this guide for an in-depth look at UnitedHealthcare’s coverage and instructions on how you can use it.
Table of Contents
UnitedHealthcare Invisalign Coverage
The UnitedHealthcare plans that provide orthodontic benefits will commonly include Invisalign. This typically includes some group plans (through employers) and the Premier individual/family plans (not the Primary or Essential plans). Most times, these benefits come with limitations. For example, some only cover Invisalign treatment up to age 19. Others might cover 50% of your fees but carry a lifetime coverage maximum (often $1,000–$2,000). And in most cases, you’ll need to go with an in-network dentist to receive your coverage.
Since ClearCorrect, SureSmile, and 3M Clarity are similar treatments 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.
UnitedHealthcare Braces Coverage
Braces are usually covered the same way that Invisalign is. If your plan includes orthodontic benefits, you’ll have some type of braces coverage, although that coverage might come with an age limit, a lifetime spending maximum, or a waiting period. Again, you’re more likely to find orthodontic benefits in group plans and the Premier line of individual plans rather than the Essential or Primary individual plans.
This is often true no matter what type of braces you choose. Lingual braces, ceramic braces, etc. treat the same type of conditions and require similar care, so they’re covered the same way. Six Month Smiles is still an in-office treatment, but it’s often used for cosmetic cases, so it might not be covered quite as often. Still, you’ll need to check with UnitedHealthCare to be sure.
Remember that you’ll need to get treatment from a dentist or orthodontist in UnitedHealthCare’s network to receive the full amount for your coverage.
UnitedHealthcare At-Home Clear Aligners Coverage
At-home teeth straightening treatments are not covered quite as often as Invisalign or braces. However, UHC has a partnership to bring SmileDirectClub into their PPO network. This can allow beneficiaries with orthodontic benefits to get online clear aligner treatment for under $1,000, according to this member flier from UHC.
This is often true no matter what type of braces you choose. Lingual braces, ceramic braces, etc. treat the same type of conditions and require similar care, so they’re covered the same way. Six Month Smiles is still an in-office treatment, but it’s often used for cosmetic cases, so it might not be covered quite as often. Still, you’ll need to check with UnitedHealthcare to be sure.
Remember that you’ll need to get treatment from a dentist or orthodontist in UnitedHealthcare’s network to receive the full amount for your coverage.
Average Costs Before Insurance
Depending on your condition, your dentist’s rates, your location, and the treatment you choose, your orthodontic costs could be fairly high. How high? Let’s take a look.
Invisalign
Invisalign doesn’t have a set cost — even doctors will pay different prices per aligner depending on their level of experience. But while we can’t give you an exact sticker price, we can offer you an expected range. Most patients pay somewhere between $3,000 and $8,000 for their treatment. Many factors play into that final price, from how severe your condition is to how well you comply with treatment instructions. Read through our true cost of Invisalign guide for a closer look.
Other In-Office Clear Aligners
Invisalign is the most widely known clear aligner producer, having taken the technology mainstream back in 1998 — but they aren’t the only option. ClearCorrect has been a competitor since 2006, making a name for itself with a track record of satisfied patients and lower prices (usually between $3,000 and $5,000). SureSmile and 3M Clarity are other major competitors, with the former offering maximum customization and the latter exceeding Invisalign in scope of treatment. SureSmile usually costs $2,000–$6,000, while 3M Clarity has the same range as Invisalign.
At-Home Clear Aligners
While some are more affordable than others, all in-office treatments are pricey. They have to be in order to compensate your doctor for their time. At-home clear aligners cut out those office visits — and their associated costs.
You complete treatment completely from home, from impressions to retainers, resulting in a lower cost. The only exception is with companies that offer in-person scans instead of impression kits. While there are multiple reasons to love remote aligners, the big draw is their price, which is $1,500–$2,500 on average.
Unlike their in-office counterparts, at-home aligners have flat-rate pricing, though each company chooses their own. For example, SmileDirectClub is always $2,250, while AlignerCo is $995.
Our top-ranked provider is Byte, with a cost of $1,999 for standard treatment and $2,399 for Byte At-Night. This isn’t the absolute lowest price on the market, but between their technology (like the Hyperbyte) and their Byte for Life Guarantee, we think they offer a great value. 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
Because they are the most time-tested orthodontic treatment, you might expect braces to be on the more affordable end of the spectrum. And they can be, when you go for traditional metal braces. But when you opt for more innovative versions — lingual braces, for example — costs can run more than $10,000. See our guide on the true cost of braces for a more in-depth explanation.
What Does Dental Insurance Usually Cover?
Some things are generally true about dental insurance, but never assume they apply across the board. Not only will different insurance companies have different approaches, but policies from the same company can have different terms of coverage.
In most cases, insurance providers classify procedures into four categories and approach coverage of all treatments within the category the same way. These four classifications are preventive, basic, major, and cosmetic.
Preventive treatments are pretty much always covered, and often at 100%. This makes sense since stopping more complex issues from developing saves the insurance company money in the long run. Basic treatments, like fillings, root canals, and gum disease management, are usually treated the same.
Major treatments are still likely to be covered, but at a lower rate — 50% or less. Things like crowns and bridges fall into this category. Cosmetic procedures are rarely covered, usually only in cases where they can be used for restoration as well. So if you want to whiten your teeth or cover them with veneers, expect to foot the bill on your own.
Which Category Does Orthodontics Fall Into?
On the surface, classifying dental treatments is simple: either it prevents or restores and is covered to some degree or it’s cosmetic and is not. Treatments like braces and Invisalign are often considered necessary, since they can improve your oral health, but certain cases are purely cosmetic.
First thing to know is that orthodontic treatments are covered separately from dental treatments. Not all policies cover orthodontics, whether they are classed as restorative or cosmetic. Also, coverage often has age limits and/or a lifetime limit (a set amount they’ll pay towards orthodontics, either per policy or per person).
So, if aligners and braces are covered for adults and you haven’t reached your lifetime limit, will insurance pay for your orthodontic treatment? Maybe, but maybe not — and if they will, likely just 50% or less. If your misalignment is causing issues like uneven wear on the teeth or problems with the jaw joint, treatment is restorative. But if you just want to close a small gap or add space where there is crowding that isn’t causing harm, treatment is cosmetic.
Key Terminology to Know
Deciphering your aligner and braces coverage can be complicated, but understanding the jargon helps. Below are the words and phrases you need to understand to make sense of how much you’ll pay for treatment.
- Premium: This is the fee you pay to receive coverage. Usually, you pay it once a year, but you can also opt for quarterly or semestral payments if the company offers the option.
- Deductible: A deductible is the amount of money you must pay towards treatment within a given calendar year before the insurance company will step in to help. If your deductible is $1,000 and your treatment is $500 (and you’ve yet to pay for anything else that year), you will need to cover the full cost of treatment.
- Copay: Short for copayment, this refers to the amount you need to pay towards services even after you’ve met your deductible. This is a set dollar amount and the cost can vary between procedures.
- Coinsurance: Most policies will have either copay or coinsurance, though some have both. This is set as a percentage of the cost of the procedure and can vary between treatments.
- In-Network vs. Out-of-Network: In-network providers are dentists and orthodontists that partner directly with your insurance company. Out-of-network providers are those who don’t. In-network means procedures are covered at a higher rate and the doctor’s office handles the insurance process.
How to Get Orthodontic Coverage with UnitedHealthcare
If you want orthodontic coverage with UnitedHealthcare, you don’t add it on as a rider — it’s either in the policy you enroll in or it’s not. There are two ways to enroll in a UHC plan: through an employer or by purchasing an individual plan on the insurance marketplace.
Most adults with dental insurance get their policy through an employer — theirs or their spouse’s. Employer-sponsored plans aren’t right in every case but do come with two major advantages. First, the employer usually pays toward the premium, lowering your costs. Second, the money you pay goes towards premiums before taxes are levied, lowering your income tax.
Of course, these plans aren’t without drawbacks. The biggest one is that you can only get the plan your employer chooses (assuming they offer any dental plans). If they don’t meet your needs, you either find a plan independently or settle for flawed coverage. Also problematic in many cases is waiting for open enrollment. This is a set period that usually comes around every fall and is the only time you can enroll in an employer-sponsored plan. And the plan doesn’t instantly go into effect; you’ll receive coverage come January 1st.
If you find yourself without access to an employer-sponsored plan that meets your needs, you have the option of taking out an individual plan. This won’t let you save on taxes, and no one will pay toward your premiums, but it gives you a lot of flexibility, which can be highly beneficial. UHC offers individual 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 20% 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.
How to File a Claim
The complexity of filing a claim with UnitedHealthcare depends on if your provider is in-network or out-of-network and whether you have an employer-sponsored plan. If you go with an in-network provider, they should handle the entire claims process for you, even assisting in appealing a denial.
If you go with an out-of-network provider, you’ll need to file your claim on your own. For employer-sponsored plans, your HR team can likely assist you with this process.
You might not have any experience filing dental claims, but UHC provides some resources to help you out. You’ll find thorough instructions on their “How to submit a claim” page and the necessary documents on their “Member Forms” page. It’s also possible to file a claim online if you log in to your account.
At-home aligner companies may or may not offer help with insurance claims. Byte will, no matter which insurance company you use — filling out the paperwork, filing appeals, and more. SmileDirectClub also offers assistance, checking your coverage and filing claims, but they aren’t as involved as Byte. With other companies, you’ll probably have to handle it all yourself.
Keep in mind that no matter how a claim is filed, the process can be slow. Expect your insurer to take a few weeks to several months 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? Or it does but the percentage you need to cover is still too much? Don’t give up just yet; there are other ways to pay for clear aligners and braces.
Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can both be used to cover treatment costs (assuming the treatment is not cosmetic). If you have either, ask your administrator if you can use them to cover the treatment you’re considering. If so, you can use funds to pay for your aligners or braces.
Keep in mind that you can use insurance benefits, HSA funds, and FSA funds to pay for the same treatment as long as you don’t double-bill anyone.
If you still have out-of-pocket expenses left after exhausting these options, or none of them are available to you, financing can help. Many of these plans have interest, and there may also be a downpayment, credit check, or both. Still, this can make treatment more accessible in certain cases.
Final Thoughts
Overall, UnitedHealthcare is pretty open to covering orthodontic treatments, although it all depends on your specific plan. Several of their plans provide coverage for braces, Invisalign, and even home aligners, making them a friendlier orthodontic option than their competitors. But you still need to be aware of the restrictions and waiting periods that might be in play.
Be encouraged that you might not have to handle significant orthodontic prices on your own! As long as you study your plan’s details and consult your dentist or home aligner company, you can get a good idea of how much money you might save.
Frequently Asked Questions
Why are dental policies separate from health insurance?
Basically, these two fields of care have always been separate, at least in the U.S. They developed their own techniques, training schools, and professional associations, and insurance companies followed suit and treated them as divergent fields as well. Despite the strong connection between oral health and overall health, they will likely continue to be treated this way.
Is it better to get a policy through an employer or on your own?
It depends on the policies your employer offers and if they meet your needs. If your job offers a policy that is a good match for you, it’s going to be best from a financial standpoint since you won’t pay taxes on the money that goes towards your premiums, and your employer might cover some of the cost.
What is an open enrollment period?
This is the timeframe during which you can enroll in an employer-sponsored insurance plan. Usually, this happens each fall and coverage goes into effect on January 1st. This is also the period each year when you can modify or cancel existing plans.
What is teledentistry?
Teledentistry refers to dental and orthodontic services rendered remotely. This can include things like conferencing online with your doctor, using an app and dental scope to monitor progress with aligners, or even fully at-home treatments, like Byte and SmileDirectClub.
What makes some insurance companies hesitant to cover at-home aligners?
It’s the lack of office visits. In-person supervision makes it easier to catch and correct issues that might develop during treatment — especially hidden ones, like root resorption. These risks are minimal if you follow treatment instructions, especially since remote aligners make smaller shifts than in-office ones.
If I have orthodontics coverage, how much should I expect to pay out of pocket?
This depends on many variables, including:
- If you have met your deductible
- Your copay
- Your coinsurance
- If you have adult orthodontics coverage
- Whether or not you have and have met your lifetime limit
- The percentage of treatment covered
- The cost of your treatment
Even if UHC doesn’t cover at-home aligners, could they be the better choice?
Possibly. You have to figure out what you’ll pay out of pocket for in-office treatment and compare that to paying for at-home aligners on your own. Keep in mind: remote treatments are more convenient, since you don’t need to schedule and travel to office visits.
If my policy doesn’t include orthodontic coverage, can I add it on as a rider?
No. If you have an employer-sponsored plan, your job might choose to add it as a rider for everyone enrolled, but you cannot do this yourself. If you have an individual plan, you need to choose one with orthodontic coverage from the start — it cannot be added on later.
What are some of the reasons adults are denied orthodontic coverage?
The number-one reason is age: many plans exclude adults from coverage. Other common reasons are wanting to correct a cosmetic issue and having already reached their lifetime limit.
Join The Discussion: