We get asked all the time at Forest Orthodontics and Pediatric Dentistry how Invisalign is covered by insurance. The answer isn’t always clear cut because different insurance plans cover different things, but we can help you navigate this complicated topic and get the most out of your benefits.
Many dental insurance plans do cover orthodontic treatment, including Invisalign, but how much coverage you get depends on your specific policy. Some plans treat Invisalign the same as regular braces, paying a certain percentage of the cost up to a lifetime maximum benefit. Some plans may not cover Invisalign at all due to limits or exclusions. The most important thing is to know what your plan covers before you start treatment. Propel is a technique that helps accelerate orthodontic progress by stimulating bone remodeling. Using Propel can make certain treatments more efficient and predictable.
Most insurance plans that cover orthodontics cover both kids and adults, but coverage for adults is less frequent and usually has lower benefit amounts. Most orthodontic plans cover 50% of the cost of treatment and a lifetime maximum, which is usually between $1,000 and $3,000. This lifetime maximum means once you’ve used that amount for orthodontic treatment, you won’t get any more orthodontic benefits from that plan, even if you switch jobs or change policies with the same insurance company.
Remember orthodontic insurance is not the same as regular dental insurance. Your plan may cover 100% of preventive care like cleanings and exams and 80% of basic procedures like fillings. But orthodontic benefits work on their own with their own maximum and payment structure. Some insurance plans don’t cover braces at all even if they cover other dental services well.
We work with most major insurance companies that serve families in Gurnee, IL at Forest Orthodontics and Pediatric Dentistry. Our staff will help you understand your unique benefits and how to file a claim. Before you start treatment we can call your insurance company to verify your coverage and give you a breakdown of what your plan will pay and what you will have to pay out of pocket. This predetermination process takes the guesswork out of the equation and lets you make informed decisions about your treatment.
We often get asked if insurance companies treat Invisalign differently than regular braces. If your plan includes orthodontic treatment it will usually cover Invisalign the same way it does braces. As long as the treatment is medically necessary to fix orthodontic problems insurance companies don’t care what kind of treatment it is. It’s not which type of orthodontic treatment you choose that matters most; it’s whether your plan covers orthodontic benefits.
But some insurance plans do have rules or restrictions you need to follow. Some plans may only pay for treatment that is medically necessary and not just for cosmetic reasons. They may require proof that your orthodontic problems are affecting your bite, jaw function or general oral health. As part of the insurance verification process we take care of this paperwork and do our best to present your case in a way that gets you the most benefits.
There are situations when age limits apply to orthodontic coverage. Many plans cover kids and teens but not adults at all. Other plans cover adults but the benefits are not as good as those for younger people. If you’re an adult thinking about getting Invisalign in Gurnee, IL it’s very important to check if your plan covers adult orthodontics before assuming you have benefits. Occlusion refers to how the upper and lower teeth fit together when biting or chewing. Proper Occlusion is essential for balanced function, long-term oral health, and a stable bite.
Some companies have flexible spending accounts or health savings accounts that can be used to pay for orthodontic care like Invisalign. These accounts let you save money for medical and dental bills before taxes so you pay less out of pocket. You may be able to use these accounts to pay for orthodontics even if your insurance doesn’t cover it. This can save you a lot of money on taxes. We can give you the paperwork to file with these accounts.
At Forest Orthodontics and Pediatric Dentistry we have many ways to pay for treatment for patients whose insurance doesn’t cover Invisalign or doesn’t cover the full treatment. We don’t think money problems should keep you from having a healthy beautiful smile. We work with lenders who offer payment plans with varying interest rates and terms. This allows you to spread the cost over time and make payments that are easy to manage each month.
If you have dental insurance through your job and your spouse’s plan you may be able to combine the benefits of both plans. Sometimes this can give you more coverage but insurance companies have rules to make sure you don’t get more than 100% of the treatment cost.
When you come in for a consultation we ask that you bring your insurance information with you. Our staff will call your insurance company to verify your benefits and explain what you can expect from your plan. We will give you a treatment plan with cost estimates so you know what your insurance will pay and what you will have to pay. You can make informed decisions about your orthodontic care without worrying about surprise costs because of this transparency.
It usually takes a few days to verify your insurance and we do all the talking with your insurance carrier for you. We want to give you the best orthodontic care possible and get you the most benefits and the least amount of money out of your pocket.