Does Insurance Cover Clear Aligners?

If you’re considering clear aligners to straighten your smile, one of the first questions you’re likely to have is whether your dental insurance will help cover the cost. 

While clear aligners are a popular and effective way to achieve a healthier, more confident smile, understanding your insurance benefits can feel overwhelming. Let’s break it down so you feel informed and empowered to start your smile journey.

The short answer is: it depends on your plan. If you have orthodontic coverage, then your clear aligner treatment will be covered within the limits of your dental insurance policy. Many dental insurance plans include orthodontic benefits for clear aligners, such as Invisalign® or Angel Aligners. However, coverage can vary based on:

• Your specific insurance provider and policy
• The reason for treatment (some plans cover medically necessary orthodontics but not cosmetic care)
• Age restrictions (some plans only cover dependents under 19)

It’s common for insurance to cover a percentage of the treatment cost or offer a lifetime maximum benefit. The remaining balance becomes your responsibility.

Be sure to consult with a financial coordinator to verify your insurance benefits before you start treatment, so you’ll have a clear understanding of your expected out-of-pocket costs.

The type of insurance plan you carry will determine the orthodontic coverage you can benefit from. Here’s an overview of the different types of plans and what they typically cover:

• PPO (Preferred Provider Organization) Plans
  PPO plans are among the most common types of dental insurance. They offer flexibility to see both in-network and out-of-network providers. If your orthodontist is in-network, you’ll typically receive higher coverage percentages and lower out-of-pocket costs. PPO plans often include partial coverage for clear aligners, especially when treatment is medically necessary.
• HMO (Health Maintenance Organization) Plans
  HMO plans usually require you to choose a primary care dentist and obtain referrals to see specialists, including orthodontists. Coverage is often more limited, and you may be required to use only in-network providers. Some HMO dental plans do not cover clear aligners or only cover traditional braces, so it’s essential to confirm your specific benefits before starting treatment.
• Indemnity (Fee-for-Service) Plans
  Indemnity plans allow you to see any provider without network restrictions. These plans typically reimburse a percentage of the “reasonable and customary” charges for a given service, and you will be responsible for paying the difference between that amount and your orthodontist’s actual fee. If your plan includes orthodontic benefits, you may have more freedom in choosing clear aligners. However, you may need to pay upfront and submit claims for reimbursement.
• Employer-Sponsored Dental Benefits
  Many employers offer dental plans that fall into one of the categories above. Review your benefits booklet or consult with your HR representative to determine precisely what is included in your benefits.
• Flexible Spending Accounts (FSA) and Health Savings Accounts (HSA)
  Even if your insurance doesn’t cover aligners, these accounts allow you to set aside pre-tax dollars to pay for eligible orthodontic expenses, including clear aligners.

If you’re unsure what type of plan you have or how it works, bring your insurance card to your consultation. Orthodontic teams usually have experience working with several different types of insurance, and they will guide you through the process step by step.

Insurance providers often make a distinction between treatment that is for aesthetic purposes and treatment that is medically necessary:

• Cosmetic treatment is focused solely on improving the appearance of your smile.
• Functional or medically necessary treatment addresses bite issues, jaw misalignment, or other issues that can affect oral health and function.

Many insurance policies are more likely to cover clear aligners when there is a functional need, such as difficulty chewing, significant crowding, or jaw discomfort.

During your consultation, your doctor will assess whether your case is medically justifiable. If they deem it is, you may have a better likelihood of receiving insurance assistance.

Navigating insurance doesn’t have to be confusing. Here are a few steps to help you get started:

1. Review Your Policy Documents
   Look for details under orthodontic benefits, including coverage percentages, waiting periods, and lifetime maximums.
2. Call Your Insurance Company
   Ask specific questions, such as:
   • Does my plan cover clear aligners, such as Invisalign or Angel Aligners?
   • Are there any age restrictions?
   • Is pre-authorization required?
3. Bring Your Insurance Information to Your Consultation
   Often, you’ll be able to meet with a financial coordinator during your consultation who will help you understand what your insurance provider covers so you can maximize any available benefits.

We work with many dental insurance plans and will file claims on your behalf as a courtesy. Even if your insurance only covers part of your treatment, or none at all, you have options at Olive Orthodontics. We believe that a confident smile should be within reach for every patient.

Clear aligner treatment is an investment in your health and confidence. The cost will vary depending on the complexity of your case and the length of your treatment plan. The type of aligners you choose will also affect the price of clear aligner treatment. Our practice offers three kinds of aligner systems: Oliv Aligners, Invisalign, and Angel Aligners.

Before you start your smile journey, we’ll provide you with a precise and detailed estimate, so there are no surprises. To make your treatment manageable and stress-free, we offer:

• Interest-free financing plans with predictable monthly payments

• Discounts for paying in full at the start of treatment

• Access to FSA, HSA, CareCredit, and Cherry to help spread out costs

• Flexible scheduling so you can get started when it’s convenient

Our team will guide you through every option, ensuring you feel comfortable and confident about your investment.

If you’d like to explore clear aligners and understand exactly what your insurance covers, schedule your complimentary consultation today. You can also contact us by calling or texting (314) 624-9373.

We’ll review your benefits, provide a detailed cost estimate, and address all your questions so you can make an informed decision that’s right for you.