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Does Insurance Cover Invisalign in North Carolina?

Invisalign is a great way to straighten your teeth, especially since the trays are removable and a lot less noticeable than metal braces. But you pay more for those added conveniences. We get many patients asking us: Does insurance cover Invisalign?

The answer is, many times, yes… but a lot depends on your insurance company, type of coverage, and whether your mouth alignment can be considered a medical issue.In North Carolina, most major providers of dental insurance will partially cover the cost of Invisalign, chipping in anywhere from 25% to 50% of the total cost. These often do come with lifetime limits, however. This limit can be as low as $1000 or as high as $3500, with the average being about $1750.

Sometimes you can get around the lifetime limit if Invisalign is medically necessary to treat a more extreme problem with your mouth or jaw. In these cases, insurers will want some kind of proof Invisalign was deemed medically necessary. For example, they might want to know that your current alignment would increase the risk of tooth decay or infection, or that it is causing problems eating or speaking. Your orthodontist should be able to make this case for you and present it to your insurance company. So, does insurance cover Invisalign? Find out below!

Specific Major Insurance Carriers

We’ve gathered information from the most common insurance carriers here. But, as always, you should speak directly to your insurance agent or contact your insurance company. Plans change all the time, and it is possible that your plan will start or stop covering Invisalign at any time before you start.

As you call around, keep in mind: Most insurance plans cover treatment in general, not specific products. So, when asking about insurance coverage, start by asking if your dental plan covers orthodontics. If it does, it should cover Invisalign. (Of course, it won’t hurt to ask directly “Does insurance cover Invisalign in my case?” as well.)

Woman wondering, "Does insurance cover Invisalign?" before she tries it out.

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Does Blue Cross cover Invisalign?

Unclear, but probably not.

Blue Cross/Blue Shield does not mention Invisalign nor orthodontics specifically in its dental plans, but it does stipulate that plans do not cover treatments that are cosmetic. Other BC/BS members have found that, if you are over 18, Invisalign (or any type of braces) are almost always considered cosmetic.

Does Cigna cover Invisalign?

Yes...if it is listed on your Patient Charge Schedule (PCS). This is more often the case when you switch to a Cigna plan from another insurer that covers Invisalign; Cigna “grandfathers” in the benefits so you can finish treatment.

That said, Cigna also warns that braces usually fall under cosmetic dentistry, which is usually not covered if you are 18 or older. Again, exceptions can be made if braces are somehow deemed medically necessary.

Does Aetna cover Invisalign?

Sometimes, depending on your plan. Some plans do cover orthodontics, while others do not. Some plans also have age limits. If your plan does cover orthodontics, you do not need a referral, though Aetna DMO® plan members must use an in-network orthodontist.

 

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Does Metlife cover Invisalign?

Metlife’s plans vary widely, so you will need to check your specific plans for details. You can do this by going to www.metlife.com/mybenefits and navigating to “My Plan Coverage.” The more generous plans cover about 40% of the cost, up to the lifetime maximum.

Does Humana cover Invisalign?

Yes; many Humana dental insurance plans do cover orthodontic care for adults and children. Plus, the discounts are significant. Again, like most insurance companies, the amount covered varies depending on your plan.

Importantly, Humana (unlike some other companies) does not regularly cover treatments started before you sign up for one of their dental plans. So be sure you have your coverage with Humana first before your orthodontist starts work.

Does Insurance Cover Invisalign? Remember These Steps:

  • Shop around. Many orthodontists and dentists now offer Invisalign, and the procedure is fairly routine. It may pay to find someone with a lower price or better discounts and deals. For example, if you live in North Carolina, you can take advantage of the great deals we have here at The Happy Tooth.
  • Also try to find an “in-network” orthodontist to work with, if possible. This will make your insurance company more likely to help, and they will often cover more of the treatment.
  • Check and see if the orthodontists you are considering are Elite Invisalign providers. Elite providers have a proven track record of success with treatment, with many satisfied patients. This means less chance of unforeseen complications and better-established relationships with most insurance carriers.
  • Have your plan in place before starting treatment, if you can.
  • Talk to the orthodontist you pick to make sure he or she takes your form of insurance.
  • Discuss payment plans. Many orthodontists offer such plans to help their patients spread out the cost of treatment.
  • Ask if there is any way in which you can consider your aligners medically necessary. You never know!

Are you still trying to decide between Invisalign and braces? Download our free eBook for info on both!Invisalign vs Braces eBook

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