Invisalign started off as an orthodontic treatment that intrigued people but came along with some skepticism. How is it possible that flexible plastic trays change the positioning of teeth? Today, it has proven its worth as an effective way to treat misalignments, spacing issues, and more. Since people choose clear aligners over braces because of their aesthetics, it’s commonly thought that insurance won’t cover them. But is Invisalign covered by insurance? Let’s shed some light on the topic.
What Makes Invisalign Different Than Braces?
Before discussing insurance coverage and financing, you should know how Invisalign differs from braces and why there’s doubt that a provider would cover this particular treatment. Both modern braces and Invisalign clear aligners shift your teeth to improve the appearance of your smile and reduce the risk of oral health issues. Either option can correct spacing problems, gaps, misalignments, and other similar issues.
Braces shift each tooth individually, while Invisalign moves them collectively. In many cases, that makes Invisalign a quicker treatment. Conversely, it means that clear aligners can’t always treat more complex orthodontic concerns, which is when braces are the best option.
Rather than wearing archwires and brackets set on your teeth until the treatment ends, Invisalign uses clear aligners that you change every one to two weeks. You take them in and out to eat and clean your teeth. You must need to wear them between 20 and 22 hours per day for them to fully do their jobs.
The aligners continuously change throughout the entire course of your treatment to keep pushing your teeth in the right direction. With braces, you must come in for adjustments to keep your treatment progressing as desired. This includes tightening the wires and changing the ligatures to keep the treatment progressing steadily and the teeth shifting how they should.
How Insurance Claims Work
Before giving you a yes or no answer on whether Invisalign is covered by insurance, you should understand how dental insurance works in general. It’s not necessarily as simple as your policy covering clear aligners or not.
When we submit the claim to your insurance, we submit it as an orthodontic procedure and don’t have to use a particular code for Invisalign specifically. Therefore, your insurance won’t automatically decline it because you’re opting for Invisalign over braces.
We may need to submit diagnostic imaging and the treatment plan details. Technically, the insurance company could deny the claim if it’s Invisalign, but that’s usually not the case.
What Affects Insurance Approval
There are various factors that can impact whether insurance will cover your Invisalign.
Must Have Orthodontic Insurance, Not Just Dental
Even if you have dental insurance, you may not have orthodontic care coverage. This is an add-on to a standard policy.
Age Limitations
There could be specifications that limit you to braces only, but that’s not typical, especially with major insurers. Your policy, however, may limit orthodontic treatments to children only, usually those under 19.
Aesthetic vs. Medically Necessary
If we can’t indicate a reason why you need orthodontic treatment for oral health problems, meaning it’s only a cosmetic treatment, you may not receive coverage.
Lifetime Maximums
Most orthodontic dental insurance policies have a lifetime maximum. If you’ve reached it already, the policy won’t cover your Invisalign treatment, or it will only cover up to the remaining amount. For instance, if you only have $500 remaining, that’s all the insurance will cover for your treatment.
To clarify, each individual on your policy has their own lifetime maximum. Let’s say the lifetime max is $1,500. You, your spouse, and each one of your children all have their own maximum at that amount.
Deductible
Just like car insurance and medical coverage, there are deductibles on dental insurance. You have to pay this amount first before the insurance will cover anything.
You could have a separate deductible for orthodontic coverage, something like $50 or $100 per person. Once you pay that out of pocket, the insurance will kick in for Invisalign. In most cases, though, you don’t have a specific deductible for orthodontic care; it’s the same as the rest of your dental insurance policy’s deductible. Insurance already limits coverage for orthodontic care, which is why this is the case.
Waiting Periods
Waiting periods are common for orthodontic care. Invisalign and other orthodontic treatments are more expensive than routine dental care. Insurers don’t want to pay for the treatment only for you to cancel your coverage shortly after. So, you might have to wait six to twelve months after you get a dental policy for your orthodontic coverage to be usable, which includes Invisalign or braces. The same wait time applies if you’re seeking Invisalign for a teen or younger child.
What to Do if Insurance Won’t Cover Treatment
No matter the reason why insurance isn’t covering your orthodontic treatment, you have other options. If you have a Health Savings Account (HSA) or Medical Flexible Spending Account (FSA), the money you have in the account can go toward your orthodontic treatment, including clear aligners themselves, the diagnostics, and the orthodontist’s time. Keep in mind that you need to have a medical reason to use the money in these accounts, so you can’t use them for solely aesthetic treatments.
CareCredit and other medical loan companies are another option. You can take a loan out to cover the total cost of treatment, pay monthly fees, and cover any aftercare expenses, such as retainers.
Taking out a secured or unsecured loan, charging it on a credit card, or saving for the treatment are other options. Try talking to the billing department at the office to find feasible solutions.
How We Help with the Insurance Process
Insurance jargon is complex. Your coverage book uses words that aren’t always understandable and phrases things in a way the average person doesn’t understand. We simplify the process of determining your coverage. We do all the talking to the insurance company on your behalf, so you don’t have to stress.
Then, we relay the findings back to you so you know exactly how much insurance will cover and what you’ll be responsible for in the end. There aren’t any hidden fees — transparency is key.
Once you’re aware of what you’ll need to pay, we’ll even help you with financing if you need it. We’ll discuss your financial situation and establish a reasonable payment plan for your portion of the cost of Invisalign.
We also offer promotions that may reduce how much you owe and make the treatment more affordable. If you don’t see anything now, check back in the future because our promotions are always changing.
Truly answering whether Invisalign is covered by insurance isn’t cut and dry. Your insurance policy, as well as how much you’ve used it so far, all factor in. However, at WOW! Smiles, Dr. Bernstein and our other orthodontists are here to make life easier for you when it comes to straightening your teeth. We’ll assist you with navigating the insurance process and much more.
Book your free consultation and discover just how affordable Invisalign can be with or without adequate insurance. Call (844) 900‑4969 today.
FAQs
The cost of Invisalign can be an obstacle hindering you from getting the beautiful smile you’ve always wanted. At WOW! Smiles, we will do everything we can to help, starting with answering questions you may have before you even get here.
How much does six months of Invisalign cost?
Generally, if you only need six months of Invisalign treatment, you have a mild or moderate case. You can expect to pay around $4,000, but the price ranges greatly depending on the number of trays you need during that time and the frequency of your visits.
Can I get Invisalign on insurance?
Though it depends on your insurance and the specifics of your case, insurance often covers Invisalign. Your insurance provider treats Invisalign as braces or other orthodontic treatments. However, you have to consider your lifetime maximum, deductibles, and whether you have orthodontic coverage or just a standard dental insurance policy.
What do I do if I can’t afford Invisalign?
You can discuss your needs with us, and we can set you up with a monthly payment plan. You don’t even have to put anything down to qualify. If you don’t finish paying by the end of your treatment, you just keep paying on it. There are also third-party financing options like CareCredit, taking out a secured or unsecured loan, or using a credit card.
What is the average cost of Invisalign?
The average cost of Invisalign is between $3,000 and $8,000, and the price depends greatly on the severity of your case.
Is it cheaper to get braces or Invisalign?
Usually, braces are less expensive than Invisalign because of the manufacturing costs, technology, and licensing required for clear aligners. However, the price difference isn’t tremendous, as the average cost of Invisalign is $4,000 and the cost of braces tends to start at $3,000 for minor, short treatments.