Does Dental Insurance Cover Invisalign with my Dentist?

Does dental insurance cover Invisalign with my dentist?

If you’ve got questions about how to best pay for Invisalign treatment, this is the article for you! We’ll cover two broad topics:

1. How insurance could cover a portion of your Invisalign treatment

2. Different ways to pay for Invisalign. 

Will my insurance cover the Invisalign treatment?

Many dental insurance plans do cover a portion of orthodontic treatment. In general, insurance plans which provide orthodontic treatment benefits qualify based on the clinical treatment – and not specifically on the method of treatment. In this case, teeth straightening is the treatment and Invisalign just happens to be the method used for that treatment.

When insurance policies do cover orthodontic treatment, it is typically a percentage and up to a lifetime maximum set by the policy. This means the insurance will cover a set percentage of the total orthodontic fee, only up to the lifetime maximum of the plan. Here are some common examples:

• 50% coverage on orthodontics with a lifetime maximum of $1,500

• 40% coverage on orthodontics with a lifetime maximum of $2,000

• 60% coverage on orthodontics with a lifetime maximum of $3,000

 There are also some common criteria on dental insurance policies which can affect eligibility:

• Age (some plans only consider dependents and/or policyholders under a certain age as eligible)

• Waiting Period (some new plans require a minimum enrollment period, such as 6 or 12 months)

• Review of Medical Necessity (plan determination of the degree or classification of treatment)

With the above information, you should be able to take a look at your insurance benefits and get a good idea of whether your plan could cover your Invisalign treatment. Additionally, you could ask your benefits manager (if your plan is provided by an employer) or call the insurance company directly. However, the best way to know for sure is to ask for us to send a pre-estimate request to your insurance company. We typically offer to do this during our complimentary Invisalign consultation appointments. The pre-estimate typically comes back from insurance in 1-3 weeks, and usually, a copy is provided both to you (or the policyholder) and us to keep everyone on the same page.

Additional notes on insurance coverage

We’ve certainly helped a great number of patients utilize their insurance coverage to pay for a significant portion of their Invisalign treatment and are happy to help coordinate it for you as well. However, it is important to note that your insurance coverage is between the policyholder / you and the insurance company – and we can only help you coordinate and file claims.

Some offices do ask that you pay the entire treatment price out of pocket and be reimbursed by your insurance. However, as a courtesy to our patients, we do help you send dental claims and only collect payment for your portion of the price. This does mean that insurance will pay us during your treatment, and typically on a monthly or quarterly basis. Therefore, if your insurance becomes inactive during your treatment, insurance can stop payments – some instances where this has occurred are:

• An employer switches insurance companies, and policies become inactive or change benefits

• An employee switches companies (quit/relocate / transfer) and thus ends their active coverage

• An employee is laid off and dental insurance is no longer active

• A patient “ages out” of eligibility and no longer qualifies for benefits

What is the best way to pay for Invisalign?

There are multiple ways to pay for Invisalign treatment at our office; take a look below to see which might be the best fit for you.

In-Office Payment Options

At our office, we offer two simple methods of payment for your portion of Invisalign treatment.

1. In-office payment plan

1. An initial deposit of $1,000 from the patient (cash / check / credit card) to start your treatment

2. Payment of the remainder of your balance in any amount, at any time, as long as it is paid in full by completion of your planned treatment

Common Examples:

1. 16-month treatment plan with a total patient portion of $3900. $1,000 initial deposit, remaining $2900 paid in monthly installments of $181.25.

2. 12-month treatment plan with insurance covering $2000, and the remaining patient portion $1,900. With a $1000 initial deposit, the remaining $900 is paid with $450 at Month 6 and the final $450 at Month 12 at end of the treatment.

3. Up-front payment with a 5% discount

1. Save 5% of your entire patient portion if paying at the start of your treatment

Tax-Advantaged Accounts

If you have an employer-provided FSA or an HSA account with your insurance plan – you might be able to pay your portion of Invisalign with pre-tax dollars. Only your FSA or HSA administrator can tell you the qualification for your individual situation. However, FSA and HSA usage is typically based on medical necessity. Orthodontics tend to have a wide range of applicability, from medically necessary changes to your occlusion to treat bite or jaw pain issues to minor movements for aesthetics only.

We have had several patients utilize their FSA / HSA accounts and we are happy to help provide the paperwork to support your record-keeping and filing. However, only your plan administrator can determine eligibility.

If you have dental insurance covering a portion of your Invisalign treatment and you are using funds from an FSA or HSA – you’re getting some good benefits! But, it’s important to note that the reimbursable amount from the FSA/HSA is only for your portion of the payment (and excludes the insurance-covered portion).

Financing Options

Looking for longer financing options or a plan without a down payment? We work with two trusted partners to provide financing for our patients:

1. CareCredit – offers 6, 12, and 18-month “Interest-Free” options for our office with no down payment required, please see the CareCredit website or give us a call for questions (you will need to qualify for a CareCredit account, which can be checked without a ‘hard credit pull’). Longer terms are also available with their traditional lending options – see the website or call us for questions.

2. Varidi – if you need a “no-credit-check” option right now, we do offer simple plans which can be established monthly, with just the initial setup fee / down payment. Please give us a call for any questions.

 Wrap Up

Invisalign treatment is a life-changing (typically, once-in-a-lifetime) procedure. We take the care and attention provided to our patients before, during, and after treatment very seriously. Consequently, we understand the pricing for Invisalign treatment is not trivial. As with all our care, we try to provide enough information for the patient to make an informed decision.

Between figuring out potential insurance coverage, treatment pricing, payment options, and even tax-advantaged accounts – the different layers and options can be confusing. This article is meant to provide you transparency into “how it all works”, but it can be overwhelming. We help coordinate the treatment planning, insurance claims, and payment options to make it easier for you. Feel free to give us a call or schedule an appointment so we can help!