FAQ

Does Dental Insurance Cover Invisalign for Adults?

invisalign is an investment in your smile, one that can last forever. as a result, it is quite expensive. Between all the office visits, dentist fees, and manufacturing costs, Invisalign can cost a few thousand dollars, which you may not be ready to pay. Fortunately, your dental insurance could help.

Invisalign treatment is sometimes covered by dental insurance plans, though it depends on your specific provider and plan. this guide will help you navigate the details of your insurance and know what to expect.

Reading: What dental insurance covers invisalign for adults

average cost of invisalign (before insurance)

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

You can even fall outside that range if you have a particularly easy or difficult condition. for example, a minor case of spacing could take less time to fix and therefore less money. while a severe case of overbite and crowding can carry a greater financial and time commitment.

how do orthodontic benefits work?

It’s natural to think that all dental insurance plans include orthodontia, but this isn’t always true. Some dental insurance plans have orthodontic benefits and some do not. and even plans that include orthodontia may have restrictions.

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

do orthodontic benefits cover invisalign?

Many times, orthodontic benefits do cover invisalign, but it depends on the plan. Generally, the most basic plans will not include any orthodontia coverage, while the most comprehensive and expensive plans will. All of the insurance companies described above have a plan (or plans) that may cover braces or clear aligners.

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This coverage may also extend to other in-office aligner treatments such as Clearcorrect and Six Month Smiles. but to be sure, you should check with your dentist/orthodontist and your insurance provider.

covered amount

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Many plans with orthodontia 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 of $1,000 – $3,000 (on average), sometimes both. Rarely, if ever, will a plan offer 100% coverage with no limit.

In addition, there are some restrictions you should be aware of when purchasing dental insurance and enrolling in a plan.

in-network vs. out-of-network

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

Most insurance providers have pretty sizable networks, especially if you’re on a ppo plan, so you should be able to find a good fit. however, if you’re convinced of an out-of-network dentist, you may need to find other ways to manage 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 to see if there is an age limit when looking at your insurance plan.

lifetime max

Many plans will also have a maximum amount they will cover for orthodontic treatment during your lifetime. these limits typically range from $1,000 to $3,000, but can be more or less, depending on your plan. For example, if your plan covers orthodontia with a lifetime maximum of $2,000 and your invisalign treatment costs $4,500, you’ll likely have to pay the $2,500 difference.

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waiting periods

Also, some plans may have a waiting period before you can use your benefits. these waiting periods can range from a few months to a full year. so if you join a plan just so you can get invisalign, be aware of possible waiting periods or you may need to put off your treatment for a few months.

how to get orthodontic benefits

Orthodontia coverage isn’t something you have to buy separately, it’s just included in certain plans. There are two ways to enroll in a suitable dental plan: through your employer or by purchasing an individual plan.

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About half of all adults in the United States receive dental insurance through their (or their spouse’s) employer. There are a couple of advantages to signing up for dental insurance through an employer plan. For one thing, insurance premiums are deducted directly from your pay before taxes, reducing what you owe in taxes. on the other hand, employers often contribute to the cost of their plans, resulting in lower premiums.

However, there are also some significant drawbacks with employer-sponsored dental plans. First, you are limited to the plan options your employer offers. This can be especially problematic if you’re interested in braces or clear aligners, as many dental insurance plans don’t cover orthodontia or offer very limited coverage. Second, employer-sponsored dental plans are often bundled with health plans, so you may have to wait for an “open enrollment” period to change your plan. Finally, many companies simply do not offer dental insurance at all.

Fortunately, even if you receive medical or dental coverage through your employer, you can always invest in an individual plan that also covers orthodontia. And, unlike buying standard health insurance, you don’t have to wait for an open enrollment period to buy an individual dental/orthodontic plan—you can enroll any time of the year!

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other ways to manage orthodontic costs

If your plan doesn’t include orthodontia benefits and you don’t have other options, you may be out of luck. But don’t worry, there are still ways to save money on your treatment.

Dental Discount Plans: Certain providers may also offer dental discount plans (or dental savings plans). these are not insurance plans. rather, they are like a subscription where you pay a monthly or yearly fee and receive discounts on certain procedures or designated dentists. sometimes these plans include orthodontic treatment.

shop around: different dentists have different fees. And there’s nothing wrong with getting multiple estimates on invisalign to compare prices. just make sure the dentist you choose is in your provider’s network or you may not be covered.

use an hsa or fsa account: these accounts are good because they allow you to make tax-free contributions that you can use later for health expenses. they are an option in many employer-sponsored insurance plans. If you have an HSA or FSA, you can use it to pay for your Invisalign treatment.

Consider clear aligners online: If you like the look of clear aligners but don’t want to pay the high prices of invisalign, you might consider getting clear aligners from a provider like smiledirectclub. they are a faster and cheaper alternative that can treat mild to moderate cases of crowding, gapping, and even some bite issues.

final thoughts

Although invisalign is expensive, take heart that you may be able to 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 the details of your plan before starting treatment.

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