Does Blue Cross Blue Shield Cover Clear Aligners & Braces?

blue cross blue shield (bcbs) is one of the nation’s largest health insurance providers. they have numerous companies under their umbrella and insure millions of Americans. but their orthodontic coverage is not as widespread. If you’re thinking about wearing braces, invisalign, or aligners at home, you may be wondering if your BCBS plan will help. the answer: it depends.

If you have blue cross blue shield, there’s a chance they’ll cover your treatment with clear aligners or braces, but there’s also a chance they won’t. Before you dive into treatment, read this guide for an in-depth look at BCBS coverage and instructions on how to use it.

average costs before insurance

Orthodontic treatment prices certainly aren’t cheap, but they can vary significantly depending on the severity of your condition, your dentist’s or orthodontist’s fees, and the type of treatment you choose.

invisalign

On average, your invisalign treatment will cost between $3,000 and $8,000. That’s a pretty big range, but only because price is subject to several influences, including the severity of your condition, the length of treatment, the dentist’s experience, and even where you live. read our invisalign actual cost guide for a closer look.

Although invisalign pioneered conventional clear aligner treatment, it is no longer the only producer. clearcorrect burst onto the scene in 2006 and has been a worthy competitor ever since. They charge less for lab fees than invisalign, so their prices can be slightly lower, often in the $3,000-$5,000 range (though up to $8,000 is also possible). then there’s suresmile, which offers an affordable and highly customizable alternative that typically costs between $2,000 and $6,000, and 3m Clarity, which makes some of the most powerful aligners out there, often costing between $3,000 and $8,000.

homemade transparent aligners

While invisalign must be administered in a dentist’s or orthodontist’s office, at-home aligners allow you to complete treatment (you guessed it) at home. A remote dentist will design her treatment and receive all her aligners in the mail, then follow her treatment plan to gradually change her teeth.

The appeal of home clear aligners is largely due to their affordability. they are often thousands cheaper than in-office clear aligner treatments, around $1,200-$2,500 on average. Unlike invisalign and clearcorrect, home aligners have a flat rate. the only difference is which company you choose. for example, smiledirectclub always costs $1950 while alignerco costs $1145.

Our highest rated provider is byte, which is $1,895 for standard treatment and $2,295 per byte at night. They’re not the absolute lowest price on the market, but their treatment lasts only four months on average and they put a lifetime guarantee on your smile. In addition, Byte will guide you through the entire insurance process, from initial coverage checks to claims and anything else you may need, making it that much easier. see our guide to byte insurance coverage for more information.

braces

The most time-tested orthodontic treatment can also be one of the most expensive. traditional braces are usually somewhere in the $4,000-$6,000 price range, though that price depends on a few factors (see our guide to the true cost of braces). Like invisalign, the exact amount depends on the severity of your condition, your orthodontist’s fees, and where you live.

It also depends on the type of braces you choose. You have a few options: traditional braces, lingual braces (which go behind your teeth), and clear/ceramic braces. special braces (lingual, transparent) often cost more than traditional braces. lingual braces, for example, can cost up to $10,000.

what does dental insurance usually cover?

Insurance companies often classify dental procedures into one of four categories: preventive, basic, major, and cosmetic.

Most plans cover 100% of your preventive treatments like cleanings. They may also cover basic treatments like fillings, gum disease treatment, and root canals in full, or they may cover a higher percentage of the price. Major treatments like crowns and bridges are usually covered at a lower rate, sometimes around 50%. plans will rarely cover cosmetic procedures, such as whitening, veneers, and tooth shaping. Of course, the percentages for each category depend on your specific plan.

Notably, some providers consider clear aligners and braces cosmetic forms of treatment, and others classify them as major procedures. Some plans will include orthodontia benefits that can help cover the cost of braces, aligners, or other procedures, while others will not.

Different providers and plans cover different procedures, so don’t assume you’ll be covered for your treatment just because you have orthodontia benefits. Also, sometimes this coverage comes with an age limit or an annual or lifetime limit.

It’s also important to know some insurance terminology to understand your plan, such as:

• deductible: the amount you must pay out of pocket before insurance pays the bill. If you have a $100 procedure, but your deductible is $500 and you haven’t paid anything yet, you’ll have to pay for the entire procedure.
• Copayment: Abbreviation for copay. a fixed amount you will pay for certain covered treatments. copays may vary by procedure.
• coinsurance: the percentage of treatment costs you’ll need to cover after you meet your deductible. also varies by procedure.
• In-Network vs. Out-of-Network: Dental providers often partner with insurance companies to provide “in-network” coverage “. When your dental provider is in-network with your insurance provider, coverage rates are typically higher and your dental provider will handle the insurance paperwork for you. coverage rates for out-of-network care are typically lower and you may need to apply directly to your insurance provider for reimbursement.

how to get orthodontic coverage with blue cross blue shield

first, we must keep in mind that blue cross blue shield is not a single company. rather, it is a “national association of 36 independent, community-based, locally operated, blue cross blue shield companies.” this includes subsidiaries such as anthem and empire. the name of your insurer may be slightly different, but you will still receive insurance from bcbs, although plan details may vary.

Secondly, orthodontic coverage is not something you have to buy separately; it is simply included in certain bcbs plans. There are two ways to join a suitable bcbs plan: through your employer or by purchasing an individual plan.

About half of all adults in the United States receive dental insurance through their (or their spouse’s) employer. There are a couple of advantages to signing up for dental insurance through an employer plan. For one thing, insurance premiums are deducted directly from your pay before taxes, reducing what you owe in taxes. on the other hand, employers often contribute to the cost of their plans, resulting in lower premiums.

However, there are also some significant drawbacks with employer-sponsored dental plans. First, you are limited to the plan options your employer offers. This can be especially problematic if you’re interested in braces or clear aligners, as many dental insurance plans don’t cover orthodontia or offer very limited coverage. Second, employer-sponsored dental plans are often bundled with health plans, so you may have to wait for an “open enrollment” period to change your plan. Lastly, many companies simply do not offer dental insurance at all!

Fortunately, even if you receive medical or dental coverage through your employer, you can always invest in an individual plan that also covers orthodontia. And, unlike buying standard health insurance, you don’t have to wait for an open enrollment period to buy an individual dental/orthodontic plan; You can enroll at any time of the year. blue cross blue shield offers individual plans in most states, but we recommend shopping around as other providers may offer more generous orthodontia benefits in your state.

invisalign blue cross blue shield coverage

There is a lot of variation in bcbs plan options because there are so many different companies under the umbrella. the details of your plan will depend on which company operates in your state and if you are receiving insurance through your employer, which ones they have chosen. no matter where you are, bcbs basic ppo plans rarely cover invisalign, or only cover treatment for anyone under the age of 19.

But some of the more expensive plans may also cover up to 50% of comprehensive orthodontia for adults. In other cases, you may be able to add orthodontia coverage to your plan, but that depends on what plans your company offers.

Because clearcorrect, suresmile, and 3m clarity are similar to invisalign, they may also be partially covered, depending on your plan. six month smiles usually treats milder cases, so it’s almost always considered cosmetic, but not always! you’ll have to check with the company and your dentist to find out.

blue cross blue shield braces coverage

braces are in the same boat as invisalign. bcbs often considers orthodontic treatment for adults to be cosmetic, so basic plans generally won’t cover it. when they’re covered, it’s usually around 50%, and there’s often a lifetime limit, though this depends on your plan. Other companies allow you to add orthodontic coverage to any plan for an additional fee. again, there is a lot of variation between carriers and plans, so you’ll need to check with your provider to be sure.

Lingual braces and clear braces are covered in the same way as they are used to treat the same types of conditions. however, six month smiles is a short-term treatment for milder cases, so your braces may not be eligible. you’ll need to check with bcbs to find out.

Remember you will need to receive treatment from an in-network dentist or orthodontist to receive the full amount of your coverage.

clear aligner coverage at home blue cross blue shield

It may surprise you, but sometimes bcbs plans cover home aligners. Anthem and Empire have established partnerships with Byte and SmileDirectClub, so those treatments are considered in-network. this does not mean that all plans of anthems and empires will cover the domestic aligners. Plans that don’t have orthodontic benefits probably won’t cover home aligners either. but let’s say you have an anthem plan that includes orthodontic benefits as well as treatment from byte or smiledirectclub. in that case, you may be covered.

what about bcbs plans that are not under anthem or empire? You may still be able to get your treatment covered, but again, you’ll need to see if you have orthodontia benefits.

how to file a claim

For in-office treatments like braces and invisalign, your dentist’s or orthodontist’s office will file an insurance claim on your behalf, so you don’t have to worry about any paperwork or other correspondence. however, they will only do this if they are in network with bcbs. If you choose an out-of-network dentist or orthodontist, you may have to file the claim yourself. If you receive insurance through your employer, your human resources department can guide you through the process.

bcbs has numerous subsidiaries that operate in different states, each with their own forms and procedures. but many of those companies have instructions and forms for filing claims on their websites. just look for the claim form for your particular company.

Home aligner companies provide different levels of insurance support. byte, for example, will walk you through the whole process. They will complete your claim so there are no errors and will also handle any ongoing communication or appeals with the insurance provider. smiledirectclub will also help you verify your coverage and file claims, and most of the time, they will also communicate directly with your insurance provider.

Other companies leave the insurance process up to you. In these cases, you will need to download the correct claim form for your business and fill it out completely. contact the home aligner company if you have any questions, as a single error on your form can cause your claim to be denied.

After you’ve filed a claim, the insurer will process it within a few weeks, or it could take a couple of months.

other options if not covered

What if you’re ready to start braces or aligners, but your current insurance plan doesn’t cover the treatment you want?

if you have a health savings account (hsa) or a flexible spending account (fsa), you can use either one to pay for your treatment. These accounts deduct money from your income before taxes and allow you to use it for qualified medical and dental expenses. They’re often an option with employer-sponsored plans, and even if you received partial coverage for your orthodontic treatment from Blue Cross Blue Shield, you may be able to use an HSA or FSA to pay the remaining balance.

If you can’t find coverage, you can always look for other ways to make the price more manageable, like financing plans. Dental and orthodontic offices will generally offer payment plans, as will most home aligner companies, although a credit check may be required to qualify. Or, you can check out third-party options like carecredit, which provide financing specifically for medical and dental expenses (these plans often require a credit check as well).

conclusion

Most importantly, you may receive coverage for your adult orthodontic treatment. bcbs is a relatively friendly insurer for orthodontic treatment. Their invisalign and orthodontic coverage is comparable to other providers, but where they shine is in their partnerships with home aligner companies. If you have BCBS insurance and are undergoing home aligner treatment, you have a better chance of being covered.

Insurance can sometimes seem like a conundrum, especially when it comes to orthodontics. But once you know the ins and outs of your plan, you should have a good idea of ​​what treatments will be covered and how you can take advantage of them. It’s always a good idea to check with your dentist, orthodontist, or home aligner provider about insurance coverage before diving into treatment.