How to Use Insurance to Pay for Clear Aligners

Clear aligners are a great alternative to metal braces. They’re removable and nearly invisible while gradually straightening your teeth.

But how can you pay for it? In this article, we’ll go over dental insurance and how you can use it to pay for clear aligners. 

Does Dental Insurance Cover Clear Aligners?

Dental insurance is typically used for preventative, restorative, and orthodontic services. Some dental insurance plans may cover clear aligners, but it’ll depend on your orthodontist as well as the brand and type of aligner.

Here are some ways to find out whether your insurance covers clear aligners:

• Ask your benefits manager at work
• Call your insurance plan’s customer service line
• Check your benefits package for ‘orthodontic treatment’

In severe cases deemed medically necessary, medical insurance can cover orthodontic treatment. This usually occurs for facial deformities, tooth impactions, and severe bite problems.

You can also ask your dentist for a detailed treatment plan and cost estimate to show your insurance provider for review. This can give you an idea of your out-of-pocket expenses.

How To Use Your Insurance to Pay for Clear Aligners

Submitting an insurance claim for aligners is similar to that of other types of orthodontic treatment. Before filing any claims, find out more information about your eligibility and coverage. 

Get a pre-estimate or pre-determination of what your out-of-pocket costs would be. Benefits vary significantly from policy to policy, so look for sections related to orthodontic care or benefits.

From here, you can find information on whether or not your insurance covers clear aligners and to what extent. Some policies might lump them together with traditional braces, while others may have specific provisions for clear aligner treatment.

Filing the Claim

Once you’re familiar with the plan, it’s easier to determine how the case should be filed. You usually need to submit the correct paperwork to your insurer. Then, the aligner company helps with the rest. 

However, the process differs depending on the insurance company and the aligner brand. Some insurance companies ask for monthly or quarterly claim submissions to continue treatment. 

In those cases, more than five claims will be submitted. Other insurance companies only pay for a maximum of 24 months of treatment. 

Separating Claims

Separating your claims allows the insurance company to pay some of the fees from the person’s annual maximum instead of their lifetime maximum. This allows some people to receive benefits from their insurance toward treatment. 

These are the people who may not otherwise have orthodontic coverage. Filing the claims separately can also help quicken the payment process and give you an idea of how the insurance company may handle claims or payments.

Can You Pay for Aligners With an HSA/FSA? 

You can use an HSA or FSA to help pay for clear aligners. However, there are limits to what types of medical care are covered. 

Anything that treats or prevents disease or related health concerns qualifies for reimbursement for dental treatment. However, treatment that addresses aesthetic concerns will not be covered. 

Brands that Cover the Cost of Clear Aligners

Although these brands cover the cost of clear aligners, they don’t offer the same benefits.

• Invisalign — Invisalign coverage depends on your insurance. Your insurance may cover a certain percentage or a specific amount for treatment. 
• ClearCorrect — If your dental insurance provider offers orthodontic benefits, they may cover some of your ClearCorrect treatments.
• Candid — If Candid is in-network with your insurance provider and you have orthodontic coverage, you can be covered for an average of $1,000 at checkout. 
• Byte — It’s possible to receive 50% coverage, depending on your insurance plan.
• NewSmile — NewSmile costs 75% less than many other clear aligner brands, which already provides impressive savings. 
• AlignerCo — Some insurers consider AlignerCo like other orthodontic treatments and offer coverage accordingly. 
• 6 Month Smiles — Some dental and health insurance plans may cover some of 6 Month Smiles treatment. 

Tips for Getting Your Insurance to Pay for Clear Aligners

When submitting your claim, be as thorough as possible. Prepare all the relevant documentation, such as treatment plans, X-rays, estimated costs, and photos of your teeth. 

This will help your providers understand the necessity of treatment and increase your chances of reimbursement. Depending on your policy, it might be best to spread out your claims throughout the year to maximize your benefits. 

For example, if your plan has an annual maximum, submitting your claims over two calendar years can potentially increase your overall coverage. Lastly, if your claim gets denied, you can try submitting an appeal with any additional supporting documents.