Does Insurance Cover Teeth Aligners? Brand Comparisons
Byte Licensed DDS
Table of Contents
- UnitedHealth Coverage
- Kaiser Coverage
- Anthem Coverage
- Humana Coverage
- Cigna Coverage
- Aligner Non-Coverage
Misaligned teeth aren't simply a cosmetic concern. Crooked teeth are hard to keep clean, and mismatched jaws force muscles to work even harder with each bite. Aligners can fix the issue, and it's reasonable to expect your health insurance to cover this necessary work.
Every health insurance company is different, and companies may even offer varying products from one state to the next. In general, if you have questions about your benefits, it's best to contact your health insurance company and ask.
But most insurance companies publish information about their plans online. Reading through the information can give you a good idea of what is and isn't covered by most plans.
Consider this article a starting point in your search for coverage for aligners. As you'll see, most insurance companies offer at least some benefits for this innovative tooth-straightening service. But how the plans work and what you’ll pay can vary greatly.
Does UnitedHealth Cover Aligners?
Two types of health care plans exist in the UnitedHealth system. Consumers can buy a plan that addresses physical health, including regular doctor visits, surgeries, and vaccines. Consumers can also purchase plans for dental health, including some with benefits involving aligners.
In a typical dental plan with UnitedHealth, consumers must:
- Understand the network. Doctors partner with UnitedHealth and agree to charge a set amount for services.
- Stick with the network. You'll get the highest reimbursement level if you work exclusively with doctors aligned with UnitedHealth.
- Keep up with premiums. Pay your bills on time, and your benefits stay with you. If you miss a payment, your benefits are at risk.
UnitedHealth dental plans offer orthodontic treatment, but it must be provided by a network doctor. You must be referred to that orthodontist by your assigned dentist.
UnitedHealth has an agreement with SmileDirectClub, and you can use that partnership to pay for aligners. But if you want to work with a different company, you may be forced to pay for care out of pocket.
Does Kaiser Permanente Cover Aligners?
Cutting costs is crucial for most health care companies. Kaiser Permanente tackles this task with a closed system model. Consumers must work with network doctors, and they're encouraged to buy products from company-owned pharmacies, opticians’ offices, and dental offices.
Companies that offer doctor-supervised, direct-to-consumer aligners don't fit nicely into the Kaiser Permanente model. And at the moment, Kaiser Permanente doesn't have an aligner partner.
But some Kaiser-affiliated dentists offer treatment with Invisalign. Those professionals work on a fee-for-service basis, meaning customers pay for the product rather than chipping in a monthly fee to access the care. This is the only way most Kaiser Permanente consumers can use their benefits to get aligners.
Does Anthem Cover Aligners?
Anthem is part of the Blue Cross Blue Shield family, and networks play a role in most plans. You're given a list of providers when you enroll, and you're asked to choose from that list when you're looking for medical care.
Every plan is different, but Anthem says most dental plans:
- Don't cover care for adults. Young people can get the help they need under an insurance plan, but parents can't.
- Come with a cap. You're given a spending limit each year. If you exceed that amount, you must pay the difference.
- Have detailed specifics outlining coverage. You're encouraged to call your plan administrator to determine just how your product works.
If your Anthem plan doesn't cover aligners, you could still get help. Discount programs run through Anthem could help you save on certain types of aligners. But your company choices are limited, so you'll have to watch the details carefully.
Does Humana Cover Aligners?
Networks are crucial to Humana too, just as they are to many other health insurance companies. But some Humana plans come with loopholes you can use to get help with costs.
If your Humana plan has a network benefit, you could use an option to step outside of the network. You'll pay more for care than you would if you stayed in the network, but Humana will help to pick up some of the tab.
To make this work, you'd pay the aligner company directly. Then, you'd submit an out-of-network claim to get reimbursement for the devices. Many aligner companies will help you fill out the forms properly, so you can get your money back in a timely manner.
Does Cigna Cover Aligners?
Both standard health care plans and dental plans are available through Cigna. In most cases, you'll work with a network of doctors. Step outside of the network, and your bills could go up. That makes using at-home aligners a little difficult.
Cigna offers coverage for one type of aligner: Invisalign. These devices are created and supervised by network dentists or orthodontists, and you must visit that professional in person to get new trays and update your progress.
If you're an adult looking for help with aligners, Cigna may not be a good choice. Cigna plans rarely offer orthodontics coverage for adults. And some don't have orthodontic coverage at all, for anyone.
What if My Insurance Won’t Pay?
If you've learned that your plan is not likely to cover aligners, don't give up.
Insurance plans are notoriously hard to parse, and sometimes, loopholes are buried in the footnotes. If you're hoping to use your benefits, it's best to call the company and ask what's covered. Explain what you'd like to do, why you need it, and where you hope to get help. Find out what paperwork the company might need from you.
Many aligner companies will handle this conversation for you. They'll contact the company, discuss your benefits, and fill out the paperwork you need.
If you discover your company won't pay for all the care you need, you have options. You can use:
Flexible savings accounts (FSAs). Tuck away money before it's assessed for taxes, and use it to pay for qualified medical expenses. Aligners fall into this category.
Most FSAs come with a time limit, so you must use the funds each year or you lose them. Aligners could be a good way to use what you have saved.
- Health savings accounts (HSAs). Set aside money before it's assessed for taxes, and use it to cover all sorts of medical expenses. HSAs don't come with a time limit, so you can spend the money whenever you'd like to.
- Payment plans. Many aligner companies offer financing at reasonable rates, so you can get the help you need without breaking your monthly budget.
California 2018, Signature Value, Dental 160. (2017). UnitedHealthcare.
UnitedHealthcare Collaborates with SmileDirectClub to Provide Coverage for Direct-to-Consumer Clear Aligners. (May 2019). UnitedHealthcare.
Summary of Dental Services. (2012). Kaiser Permanente.
Guide to Types and Costs of Braces. (August 2019). Kaiser Permanente.
Save Money With Discounts at anthem.com/ca. (August 2020). Anthem.
Are Doctor-Directed At-Home Invisible Aligners Covered Under My Plan? (September 2020). Humana.
FSAs vs. HSAs: Which is the Best Fit for You? (October 2019). U.S. News and World Report.