Invisalign has become an increasingly popular alternative to traditional metal braces for adults looking to straighten their teeth. The clear plastic aligners are virtually invisible, removable, and more comfortable than braces. However, Invisalign treatment also comes at a higher cost, leading many to wonder – can Invisalign be covered by dental insurance?
Below we’ll explore how dental insurance handles Invisalign, what factors determine your coverage, and how to get the maximum insurance benefits possible for your treatment.
Is Invisalign Covered by Dental Insurance?
Whether Invisalign is covered by your dental insurance depends on your specific plan’s coverage of orthodontic treatment. Some dental plans provide orthodontic benefits for both children and adults. Others only cover braces for those under age 18. A few may not include any orthodontic coverage at all.
To find out if your plan covers Invisalign, you’ll need to check your insurance benefits and policy documents or speak with a representative. Be aware that even plans that cover Invisalign may only pay a portion of the total treatment cost.
Does Insurance Cover Invisalign the Same as Braces?
If your dental insurance includes orthodontic coverage, in most cases Invisalign is covered the same as traditional metal braces. However, make sure to verify this with your insurance provider, as some plans only cover certain treatments or providers.
Both braces and Invisalign are prescribed by an orthodontist to reposition teeth for correct alignment and function. Since they provide the same medical result, insurance companies generally categorize them together as orthodontic treatment.
The level of coverage may be the same whether you choose braces or Invisalign. For example, your plan may pay 50% of the total fees for either option. The dollar amount will likely be higher for Invisalign since it costs more than metal braces on average.
Factors That Determine Invisalign Coverage
Several key factors impact how much dental insurance will cover toward your Invisalign treatment:
- Type of Plan – Orthodontic coverage varies based on plan type. For example, PPO and indemnity plans typically offer better coverage than HMOs or discount plans.
- Level of Coverage – Plans may cover a set percentage like 50% or 80%, a yearly maximum dollar amount, or no coverage.
- Network – Using in-network orthodontists may increase coverage compared to out-of-network providers.
- Waiting Periods – You may need to be enrolled for 6-12 months before orthodontic benefits kick in.
- Pre-approvals – Your insurance may require documentation from your orthodontist showing medical necessity before approving Invisalign coverage.
When researching plans, look closely at the orthodontic benefits and talk to insurance representatives to get a clear picture of coverage.
What Does Dental Insurance Cover for Invisalign?
The aspects of your Invisalign treatment that dental insurance helps pay for will depend on your specific plan. But in general, dental insurance can cover:
- Initial records like x-rays, photos, and impressions
- Orthodontic appliances like retainers
- Follow-up appointments for monitoring progress
- A percentage or set maximum of the total Invisalign treatment cost
Insurance does not cover cosmetic procedures without health benefits. Plans may exclude teens or adults seeking Invisalign for minor spaced or crooked teeth without bite issues.
Does Dental Insurance Cover Invisalign Retainers?
Most dental plans that cover Invisalign treatment will also provide some coverage for retainers after braces or aligners. Retainers are a required part of orthodontic treatment to keep teeth properly aligned once correction is complete.
Insurance will often cover a portion or set amount toward traditional wire retainers or Invisalign-brand Vivera retainers. However, cosmetic upgrades like clear Essix-type retainers may not be covered. Check with your insurance provider for details on retainer coverage.
Out-of-Pocket Costs for Invisalign
Even with dental insurance, you’ll likely owe some out-of-pocket costs for your Invisalign treatment. These can include:
- Deductibles
- Co-insurance charges
- Expenses beyond your annual maximum
- Non-covered services like cosmetic upgrades
- The balance after insurance pays its percentage
For example, if your plan’s orthodontic benefit is 50% coverage up to $1,500 per year, you would owe the remaining 50% plus anything above $1,500 each year.
Before starting treatment, work with your orthodontist’s billing coordinator to understand your estimated insurance coverage and your expected out-of-pocket fees.
Maximizing Dental Insurance Benefits for Invisalign
To get the most value from your dental insurance for Invisalign coverage:
- Start treatment immediately after the waiting period ends – Don’t delay, or you’ll waste the annual maximum for that period.
- Stay in-network – This usually results in higher coverage compared to out-of-network providers.
- Get pre-approvals if required – Have your orthodontist submit all needed documentation to get pre-authorized.
- Take advantage of discounts – Many dental insurance plans offer discounts on additional family members receiving orthodontic treatment.
- Use tax-advantaged accounts to pay – FSAs, HSAs, and the self-employed health insurance deduction can help offset out-of-pocket costs.
Does Health Insurance Cover Invisalign?
In very rare cases, health insurance may provide some orthodontic coverage for adults if treatment is deemed medically necessary. This usually requires severe misalignment, overbites, or other issues causing problems like impairment in eating, speaking, or breathing.
Even then, health insurance plans predominantly consider Invisalign to be an elective cosmetic treatment and exclude it from medical coverage. Don’t count on health insurance to cover adult orthodontic treatment.
To Recap
Invisalign can be a great alternative to braces for adults seeking discreet teeth straightening treatment. While rarely covered by health insurance, many dental plans do provide coverage for Invisalign, similar to traditional braces. Just be sure to thoroughly understand your plan’s orthodontic benefits and limitations.
Comparing multiple insurance options when choosing a dental provider can help you find the plan that offers the lowest out-of-pocket costs. But even with insurance, expect to pay a portion of Invisalign expenses. Proactive financial planning, tax-advantaged savings accounts, payment plans, and other options can help offset these costs.
While Invisalign represents an added expense, keep in mind that a smile you feel confident showing has physical, emotional, and social benefits that make the investment worthwhile.
Invisalign Insurance FAQs
Does dental insurance cover Invisalign for adults?
Some dental plans do include Invisalign coverage for adults, but it is less common than braces coverage for children under 18. If you are considering Invisalign as an adult, check that your plan includes adult orthodontic benefits and covers Invisalign specifically.
Can I use FSA or HSA for Invisalign?
Yes, you can use a flexible spending account (FSA) or health savings account (HSA) to pay orthodontic expenses like Invisalign that insurance doesn’t cover. Just save your itemized receipts and file claims against your FSA or HSA balance.
Does my child need a referral for Invisalign coverage?
Some dental insurers require a referral or letter of medical necessity from an orthodontist before approving or increasing coverage for a child’s braces. Check with your insurance provider to see if any documentation is needed for your child’s Invisalign treatment.
What insurance covers Invisalign the most?
No single insurer covers Invisalign the best overall. Coverage depends on the specific dental plan’s level of orthodontic benefits. But in general, companies like Aetna, MetLife, Delta Dental, Cigna, and UnitedHealthcare tend to offer solid orthodontic coverage.
Is Invisalign cheaper than braces with insurance?
Even with insurance, Invisalign generally costs more out of pocket than traditional metal braces. However, plans with co-insurance rather than set dollar amount benefits may cover a larger percentage of Invisalign due to its higher overall cost. The monthly payment difference may not be too significant.
In another related article, Dental Implants and Insurance: Does Coverage Depend on Your Plan?
