Dental insurance coverage for Invisalign

A straight smile is something that many people desire, and with the help of Invisalign, this dream is now more accessible than ever before. Invisalign is a modern, orthodontic treatment option that has revolutionized the way people think about braces. With the help of clear aligners, Invisalign makes it possible for individuals to achieve straight teeth without the use of traditional metal braces. In this blog post, we will explore dental insurance coverage for Invisalign, the average cost of Invisalign before and after insurance, and the various clauses that can impact your coverage.

The Average Cost of Invisalign

The cost of Invisalign treatment can vary depending on several factors, including the complexity of the case, the location of the dental office, and the experience of the dentist. On average, the cost of Invisalign treatment ranges from $3,000 to $7,000. This cost includes the Invisalign aligners, any necessary x-rays, and follow-up appointments. However, this cost does not include additional expenses such as retainers, dental work required before or after Invisalign treatment, or any other related expenses. The range is so wide because the cost depends on the difficulty of the case – easier, shorter cases are typically less expensive, and more complex, longer cases are more costly. 

Dental Insurance Coverage for Invisalign

Dental insurance coverage for Invisalign depends on the plan. Some insurance plans cover Invisalign treatment, while others do not. If your insurance policy covers Invisalign, it will likely fall under the category of orthodontic treatment.

Orthodontic treatment coverage typically includes a lifetime maximum benefit, which means that the insurance provider will pay up to a specific amount towards orthodontic treatment. This amount can range from $1,000 to $3,000, depending on the insurance policy. 

Dental insurance policies may also have a waiting period for orthodontic treatment coverage. This means that you will have to wait a certain amount of time after the start of your insurance policy before you can receive coverage for orthodontic treatment. Waiting periods can range from six months to two years, depending on your specific plan.

If your insurance policy covers Invisalign treatment, it will likely pay a percentage of the total cost of treatment, up to the lifetime maximum benefit. For example, if your insurance policy covers 50% of orthodontic treatment and your Invisalign treatment costs $5,000, your insurance provider will pay $2,500 towards your treatment. It is important to note that if your treatment exceeds your lifetime maximum benefit, you will be responsible for the remaining balance. 

Confusing Insurance Clauses for Invisalign

Insurance policies have clauses that can impact the amount of coverage you receive for Invisalign treatment. One of the most significant clauses is the maximum. The maximum is the total amount your insurance will pay yearly. If your maximum benefit is $1,500, and your Invisalign treatment costs $6,000, and your coverage is 50%, your insurance provider will only pay up to the maximum benefit of $1,500. This can be confusing, since it’s only natural to assume your policy would pay $3,000, but they will only pay 50% UP TO the maximum. 

Another clause that can impact your coverage for Invisalign treatment is the age limit clause. Some insurance policies only cover orthodontic treatment for individuals up to a specific age limit, often around 16 years old. If you are over the age limit, you will not be eligible for coverage for Invisalign treatment.

Finally, some insurance policies may require you to use a specific dental provider to receive coverage for Invisalign. If your preferred dental provider is not covered by your insurance policy, you may have to pay more out of pocket for your Invisalign treatment.

Final Thoughts

Getting your teeth straightened is an investment you should not take lightly. Learn everything you can about the procedure, the costs, your responsibilities of upkeep, and whether this is something you can commit to. At The Smile Lounge, we do a free 30 minute consultation to determine if you are a candidate. We will answer all your questions and be there every step of the way with you!

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