Jane Dotson
Invisalign is an emerging technology that uses clear plastic aligners to straighten teeth. It is often a more expensive treatment option than traditional metal braces due to the custom-made aligners used during treatment. Many dental insurance plans cover Invisalign, but the extent of coverage depends on the insurance provider and the patient's plan. Some insurance companies will only cover Invisalign if it is deemed medically necessary, meaning the patient has a severe misalignment that is causing pain or affecting their ability to chew or speak properly. Patients can also use tax-free dollars from their Health Savings Account (HSA) or Flexible Spending Account (FSA) to help cover treatment costs. If Invisalign is not covered by insurance, providers often offer flexible financing options to help make the treatment more affordable.
| Characteristics | Values |
|---|---|
| Insurance coverage | Some insurance plans include orthodontic coverage as part of their dental benefits. Basic health insurance plans typically do not cover Invisalign, while premium plans might. |
| Medical necessity | Insurance plans may cover Invisalign if it is deemed medically necessary, i.e., to correct significant functional or structural issues with the teeth or jaw. |
| Out-of-network coverage | Some insurance plans may offer coverage for Invisalign even if the orthodontist providing the treatment is out-of-network. |
| Insurance providers | Insurance providers such as Cigna, Delta Dental, Humana, and MetLife offer plans that cover orthodontic treatments, including Invisalign. |
| Coverage amount | Insurance may cover a certain percentage or dollar amount of Invisalign treatment costs, with some plans offering up to $3,000 in coverage. |
| Flexible payment plans | Many doctors and orthodontists offer flexible payment plans, including financing with low-to-no down payment and monthly installments. |
| Health Savings Account (HSA) | Individuals can set aside funds in an HSA to cover medical expenses, including orthodontic treatment. |
| Flexible Spending Account (FSA) | Flexible Spending Accounts can be used to pay for Invisalign treatment using tax-free dollars. |
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What You'll Learn
Dental insurance plans and coverage
Dental insurance plans can have different coverage levels, with lower coverage resulting in lower monthly premiums but higher copayments and deductibles. Some dental plans also have waiting periods for basic and major services, which can vary by state. For orthodontic treatments, there are often no waiting periods permitted for services other than orthodontia.
In the United States, dental coverage is treated differently for adults and children under 18. Dental coverage is an essential health benefit for children, meaning that dental coverage must be available for those under 18 either as part of a health plan or as a separate dental plan.
The cost of Invisalign treatment can be comparable to the cost of braces, and insurance may cover Invisalign treatment in the same way they cover braces. Depending on the insurance provider, one may qualify for up to $3,000 in coverage for orthodontic treatment, including Invisalign aligners.
If one's insurance plan does not cover the cost of Invisalign treatment, there are still options available to make the treatment more affordable. Invisalign providers often offer flexible financing options, and doctors may offer flexible payment plans with monthly payments and low-to-no down payments.
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Health insurance plans and coverage
- Basic vs. Premium Plans: Basic health insurance plans typically do not cover Invisalign, while premium plans are more likely to offer coverage. However, it is essential to check with your specific provider, as coverage may vary.
- Dental Insurance Plans: Many dental insurance plans cover Invisalign treatment in a similar way to how they cover traditional braces. Your insurance may pay a certain percentage of the treatment cost or a specific dollar amount, which can be up to $3,000 for orthodontic treatment.
- Medical Necessity: Some insurance companies will only cover Invisalign if it is deemed medically necessary. This typically applies to cases where there is a severe misalignment causing pain or affecting your ability to chew or speak properly. An orthodontist can help determine if Invisalign is medically necessary for you.
- Orthodontic Coverage: Some insurance plans include orthodontic coverage as part of their dental benefits. While this usually applies to traditional braces, it may also extend to Invisalign. However, there may be specific conditions or limitations, such as age restrictions or pre-authorization requirements.
- Out-of-Network Coverage: Certain insurance plans may offer coverage for Invisalign even if the treating orthodontist is out-of-network.
- Flexible Payment Plans: If Invisalign is not covered by your insurance, there are still options available. Many doctors and Invisalign providers offer flexible payment plans, including financing with low or no down payments. These plans allow you to make small monthly payments over the course of your treatment, making it more affordable.
- Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs): You may be able to use tax-free dollars from your HSA or FSA to help cover the costs of Invisalign treatment. These accounts allow you to set aside pre-tax dollars specifically for eligible medical expenses, including orthodontic treatments.
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Medical necessity
Whether or not your insurance covers Invisalign treatment depends on several factors, including the type of insurance you have, the specifics of your plan, and your provider. Basic health insurance plans typically do not cover Invisalign, while premium plans might. Some insurance companies will only cover Invisalign if it is deemed medically necessary.
The American Association of Orthodontists (AAO) has developed a list of auto-qualifiers that would be considered a medical necessity. These conditions include congenitally missing teeth, palate or cleft lip defects, or functional occlusal contact. Another organisation, the Pediatric Oral Health Research and Policy Center (POHRPC), is also creating a medical necessity global policy brief to better define these conditions.
In addition, medical necessity would include treatment for trauma-induced malocclusions, craniofacial abnormalities or disharmonies, and severe handicapping malocclusions that could cause harm to a child's emotional or physical health.
If your insurance covers Invisalign, it will pay anywhere between 20% and 50% of the costs. Companies that offer orthodontic coverage include Humana, Aetna, Cigna, Delta Dental, USAA Dental, Spirit Dental and Vision, and UnitedHealthcare.
If your insurance does not cover Invisalign, there are other options to make the treatment more affordable. Many doctors and orthodontists offer flexible payment plans, allowing you to pay for the treatment in monthly installments. You can also use a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for Invisalign treatment using pre-tax dollars.
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Financing options
The financing options available to you will depend on your insurance provider, your chosen Invisalign provider, and your financial situation.
Firstly, you should check with your insurance provider to see if they cover Invisalign treatment. Some insurance companies will only cover Invisalign if it is deemed medically necessary, for instance, if you have a severe misalignment that is causing pain or affecting your ability to chew or speak properly. Basic insurance plans may not cover Invisalign, while premium plans might. If your insurance covers orthodontic treatment, you may be covered up to $3,000 for Invisalign. You can use the My Invisalign app to see how much your insurance will cover.
If your insurance does not cover Invisalign, there are still options available to you. Many doctors and orthodontists offer flexible payment plans, allowing you to pay in monthly installments over a set period of time. These plans often involve setting up a financing agreement with your doctor or orthodontist and making a down payment, followed by monthly payments for the duration of the plan. Some doctors and orthodontists offer low-to-no down payment options.
You can also use your FSA or HSA to pay for Invisalign treatment using tax-free dollars. These accounts let you set aside pre-tax dollars for eligible medical expenses, including orthodontic treatment.
Additionally, companies such as HFD and Carvalho & Roth Orthodontics offer financing options for Invisalign treatment. HFD offers guaranteed approval for $7,000 or more, with no-to-low down payments for those who qualify.
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Payment plans
Some insurance companies may also provide coverage for Invisalign, but this depends on the specific plan and provider. Basic health insurance plans typically do not cover Invisalign, while premium plans might. It is recommended to check with your insurance provider directly to inquire about any requirements, limitations, or pre-authorization procedures associated with orthodontic treatment. If Invisalign is covered by your insurance, they may pay for a certain percentage or a specific dollar amount of the treatment cost. Additionally, some insurance plans include orthodontic coverage as part of their dental benefits, which may extend to Invisalign treatment. However, coverage for Invisalign may have specific conditions, such as age restrictions or pre-authorization requirements.
In cases where insurance does not cover Invisalign, there are still financing options available. Invisalign providers often offer flexible financing options, such as low-to-no down payment plans, to make the treatment more affordable. Patients can also consider using tax-free dollars from their Health Savings Account (HSA) or Flexible Spending Account (FSA) to help cover treatment costs. These accounts allow individuals to set aside pre-tax dollars for eligible medical expenses, including orthodontic treatment. Additionally, some providers may offer discounts for paying in full, so it is worth discussing financial constraints and exploring alternative treatment options with your Invisalign provider.
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Frequently asked questions
It depends on your insurance provider and your specific plan. Some medical insurance plans may cover a portion of the cost of Invisalign, while others may not. It is best to check with your insurance provider directly to find out what your plan covers.
Yes, if your medical insurance does not cover Invisalign, you may want to consider looking into dental insurance plans, which are more likely to cover orthodontic treatments. There are also specific orthodontic insurance plans designed to cover braces and aligners.
The cost of Invisalign can vary depending on the complexity of your case and the length of treatment. On average, Invisalign can range from $3,000 to $8,000, but it is best to consult with your dentist or orthodontist to get a more accurate estimate for your specific needs.
Yes, many dental clinics offer flexible payment plans or financing options specifically for Invisalign treatments. These plans can help make the cost of Invisalign more manageable by breaking it down into monthly installments.
Possibly. If you require orthodontic treatment for medical reasons, such as correcting an overbite or improving your jaw alignment, your insurance may be more likely to provide coverage. However, it is still important to carefully review your insurance policy, as some plans may have specific exclusions or requirements for orthodontic benefits.
