Does dental insurance cover Invisalign? It depends on your plan. For adult orthodontics, the American Association of Orthodontists (AAO) says most dental plans do not provide coverage. What you pay also depends on the treatment your teeth need. Hanover Dental Care can check your plan by phone.
Does dental insurance cover Invisalign?
The AAO says dental plans with orthodontic coverage usually cover both traditional braces and clear aligners equally, though each plan is different. For adult orthodontics, it says some plans offer an annual or lifetime maximum benefit. The first question for your plan is whether it has orthodontic coverage at all.
How does a plan's orthodontic benefit work?
Plans vary widely, so treat this section as a set of features to look for, not an answer about your plan.
A separate maximum, and sometimes a rider
The American Dental Association (ADA) describes a typical PPO plan design. In it, the yearly maximum applies to all services except orthodontics. That maximum is the most a plan pays in one plan year. Orthodontics has its own lifetime maximum instead, so it is capped once while other care resets each year.
How a rider works
A 2018 article from the National Association of Insurance Commissioners (NAIC) says orthodontics are generally covered through a rider on individual and group policies. A rider is extra coverage added to a base dental policy, and the article says you must have dental coverage to buy one. It names braces and retainers, not aligners. Ask whether your plan includes orthodontic coverage or sells it as a rider, and whether aligners count.
Limits written into the contract
The ADA's glossary of dental terms defines limitations as restrictive conditions in a benefit contract, such as age, length of time covered and waiting periods. A waiting period is the time between employment or enrollment and the date a covered person becomes eligible for a given benefit. Ask whether your orthodontic benefit has an age limit or a waiting period.
A review before treatment starts
The glossary defines predetermination as a process where a dentist submits a treatment plan to your insurer before treatment begins. The ADA's introduction to dental benefits says predetermination is not a guarantee of benefits. For example, an insurer may not honor an approved predetermination if the patient is no longer eligible when treatment is provided.
If you have more than one plan
The glossary defines coordination of benefits as a method of integrating the benefits payable for the same patient under more than one plan. Benefits from all sources should not exceed 100% of the total charges. The ADA's introduction adds that a predetermination does not consider any coordination of benefits.
What decides what you pay for Invisalign?
Invisalign's own website says several things affect your out-of-pocket costs: the complexity of your case, the number of aligners and your insurance coverage. The sections above cover the insurance factor. The rest depends on your teeth and on what the quote includes.
What your teeth need before and during treatment
The AAO describes clear aligners as trays that apply pressure in sequence, each one typically moving teeth a fraction of a millimeter at a time. It says the number of aligners and the treatment time vary with the individual's orthodontic issues and the movements needed to correct them. Put together, a larger movement takes more trays.
The AAO says any dental work needs to be done before the scan, because aligners are custom created to the exact shape of your teeth. It says costs can vary with the case's complexity and region.
What the quote covers
The AAO says retainers help maintain the results of braces or aligners. Ask whether the quote includes the retainer and the check-ups during treatment. Hanover Dental Care gives pricing at a consultation, so the consultation is where you get the number for your case.
Who can tell you what your plan pays toward Invisalign?
Your plan's own terms decide what it pays, so the answer comes from the plan. Hanover Dental Care works with many dental plans. Call (804) 544-2499 before your consultation and the team will check your plan for you.
What to ask when you call
When you call, ask whether the plan has orthodontic coverage, whether aligners count and what its maximum, age limit and waiting period are. Ask whether it wants a predetermination before treatment starts and whether it pays for dental work needed before the scan. If you or a family member have a second plan, ask how the two plans work together.
Financing for the rest
For the part your plan does not pay, the practice offers financing through Cherry, CareCredit and Sunbit, plus an in-house savings plan. Our Invisalign page walks through the steps from the consultation to the retainer.
Wondering what your plan does with Invisalign? Call Hanover Dental Care in Montpelier at (804) 544-2499, or send a message through our contact page.