Dental insurance isn’t a golden ticket to free healthcare. Whilst its coverage includes some procedures, it cannot accurately be described as insurance. It is not designed to protect against the full cost of potential future events as is the assumed essence of insurance; it is a plan to help offset some of the dental expenses people will encounter.
Consumer awareness of the true nature of dental insurance is of the utmost importance, as it is still considered by many to be a discretionary commodity rather than a necessity, and over 25% of patients in the US are still not covered. That being said, the evolution of the dental insurance industry has greatly increased the coverage of orthodontics for adults in insurance policies; an overview of how different dental plan providers address this issue is explored later in this article.
A Market Overview
The US dental insurance industry’s market size was quantified at $85 billion as of 2021, and experienced an increase of $8.4 billion dollars in the last decade. It has experienced an annual growth rate of 1.5% during this time, increasing faster than the economy overall. The implementation of the Patient Protection and Affordable Care Act (PPACA) in 2014 has coalesced with declining unemployment to create strong revenue growth since 2019.
Annual growth in the industry in 2021 is forecast to exceed 5.1%. The biggest driver of this is hypothesized to be the increased consumption of healthcare services and a concurrent price escalation. These trends boost spending in private dental insurance as people seek to insulate themselves from the potentially extortionate costs of dental care, whilst simultaneously guaranteeing their access to such services.
The industry is responsible for the underwriting of dental insurance policies. The benefits of each policy vary on an individual basis. Some plans may include major dental work and orthodontic benefits (potentially even at-home aligners like SmileDirectClub), whilst others will only include basic preventative coverage within their scope.
Whilst most people enroll in this type of insurance through their workplace, individual and family plans are also available. Any plan can include certain limits, such as orthodontics insurance for under-19s, or a lifetime spending maximum which the insurer will only cover up to a certain amount (typically $1500-$3000).
Different Dental Insurance Providers
It’s not unfathomable that dental treatment, orthodontic in particular, can rack up quite the bill. The average price for Invisalign, an alternative to traditional braces that was made with the purpose of being cheaper and more convenient, starts at $5000 – a price that would give many a cause to seek out financial assistance. For some, this comes in the form of insurance, but every plan is different; the most popular plan providers may be found below:
Certain plans that Delta Dental offers will cover the treatment for Invisalign, but some won’t. PPO plans may cover a percentage of the cost or grant a set sum for the treatment; the quantity of both of these options depends on the plans, but can be up to 50%. An in-network dentist or orthodontist will be required to utilize Delta coverage.
Braces coverage is far broader; several of their plans provide some form of it. All of the plans have their own limitations: some cover more for children than adults, whilst others have a lifetime limit. Lingual and clear braces fall into the same category. Same as above regarding in-network dentists and/or orthodontists.
Delta plans do not cover at-home clear aligners. No assistance should be expected for such treatments.
*All individuals are unique. Your results can and will vary.
Blue Cross Blue Shield
BCBS is an umbrella for a multitude of different companies. This means that the details of your specific plan will depend on which of the companies are included under this umbrella function in your home state. Their basic PPo plans universally don’t cover Invisalign, or only for those below age 19.
BCBS considers adult orthodontic treatment to be cosmetic, which is why braces are not included in the coverage of its cheaper plans. Where it is covered, it’s usually up to 50%; this applies to both lingual and clear braces.
At-home aligners are surprisingly sometimes included within their policies. Where BCBS companies have an established partnership with such companies, as some do with Byte, Candid and SmileDirectClub, treatments are considered in-network and thus included.
Most Aetna policies will cover at least a portion of the costs of Invisalign treatment; some plans cover around 50% of the costs associated with adult orthodontic treatment, whilst others only provide coverage to those under the age of 19. Additional limitations, such as a lifetime limit or a waiting period to access the funds, may also apply. Adult coverage is more often included in DMO plans.
Lingual braces and clear braces are treated almost identically in terms of insurance coverage as they are used to similar issues. Given that Six Month Smiles tends to treat cosmetic, rather than health, issues – they are unlikely to be included within the policies. Treatment must be provided by a dentist/orthodontist within Aetna’s network for the full sum owed under the policy to be received.
Most at-home clear aligners will not be included within the coverage of Aetna’s policies, except SmileDirectClub; due to the partnership between the two companies, the latter is included on the former’s PPO network. Despite others not being covered at the moment, this partnership does reflect a more open stance to covering home aligner treatment holistically in the future.
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For brevity’s sake, only the coverage of each of the plans examined above has been included in the analysis as we believe this to be one of the most important factors in deciding which insurance policy is correct for you. Please refer to this information resource for a more in-depth evaluation of dental insurance options and how to find a plan that covers orthodontics.
SmilePrep’s resource provides an even more extensive discussion of the full list of insurance options, as well as more information regarding them; this includes how to file a claim with each, how to get coverage with each; the average costs of each, and what dental insurance usually covers.