Does Dental Insurance Cover Invisalign? Unraveling the Coverage Puzzle
Understanding Invisalign:
Far from the stigma of traditional braces, Invisalign are clear aligners that straighten teeth in the privacy of one’s home, or appearance. However, like most cosmetic dental procedures, dental insurance rarely covers the expense.
Dental Insurance and Orthodontic Coverage:
On most dental insurance policies, orthodontic benefits are offered, but the coverage depends on the specific plan and on policy terms.
In-Network vs. Out-of-Network Providers:
Depending on your dental insurance network, some providers have preferred providers (e.g., the network I rely on). Therefore, finding an orthodontist within a network of preferred providers often makes receiving coverage for Invisalign more straightforward than if your orthodontist is an out-of-network provider.
Coverage Restrictions and Waiting Periods:
Orthodontic coverages often have waiting periods on dental insurance policies, and we usually recommend to wait until those waiting periods are complete before proceeding with the Invisalign treatment.
Medical Necessity and Cosmetic Considerations:
But coverage for Invisalign might depend on the perceived medical necessity of the treatment, not to mention if the treatment has cosmetic considerations.
Pre-Authorization and Documentation:
However, it is to your benefit to call your dental insurance carrier prior to starting Invisalign and request a pre-authorisation from your carrier for the Ortho-related requested benefits. To expedite the pre-authorisation process, we again encourage you and your orthodontist to be as clear and thorough as possible with your documentation.
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs):
You can pay for Invisalign with funds from a flexible spending account (FSA) or health savings account (HSA) – both of which can help you pay for health expenses on a pre- or post-tax basis. The American Dental Association came out with a 2011 guide on braces technologies that is well worth a read.
Alternative Financing Options:
In cases where dental insurance provides a partial coverage for Invisalign, typically in the amount of $1500, orthodontic offices also offer financing plans to make the out-of-pocket expense more affordable for the patients.
Open Communication with Orthodontist and Insurance Provider:
However, simply talking about it up front with your orthodontist and insurance broker should answer all your questions.
The Bottom Line:
Although it’s not a guaranteed benefit, there could be some dental insurance coverage for Invisalign. To learn more about your dental insurance benefits, and to see what options are available to you and your family given your circumstances, make sure you understand all the fine print in your policy, so that you can take the best action possible. Your orthodontist and insurance provider can guide you.
Conclusion:
Whether you are covered for Invisalign or not is dependent on the details of your policy as well as your provider networks, medical necessity and whether you’re using your insurance through one person or your employer (dental insurance specialists from Wikipedia). If your dental insurance does offer coverage, it might only partially cover the cost of your treatment so you will have to make a decision on how to proceed based on your personal goals and circumstances as well as whether or not your smile will be covered. It pays to have an honest conversation with your orthodontist and your insurance provider and to look at other financing options and alternatives if needed.
