Many people would like to fix a crooked smile using Invisalign or other straighteners, or get dental work done to help improve the appearance of their smiles. But getting cosmetic dentistry work done can be very expensive. Does dental insurance cover Invisalign® or other cosmetic dentistry? In some cases, it might.
Cosmetic procedures aren’t usually covered by dental insurance. Invisalign and other cosmetic devices and services are sometimes covered partially by insurance though. Dental care doesn’t just mean getting cleanings and fillings. There is a range of dental devices that people may need to help solve dental problems like crooked teeth and bruxism, or teeth grinding. Dental appliances and oral devices like sleep apnea machines, mouth guards, and clear aligners are all typically prescribed by dentists to help correct dental issues and protect teeth. Does dental insurance cover sleep devices? There’s no simple way to answer that because the answer depends on many factors. What dental insurance helps cover some of the cost for Invisalign? Guardian Direct® does, with some restrictions. Many dental insurance plans don’t cover any cosmetic dentistry services or appliances, and since aligners are usually considered to be cosmetic in nature they are not covered by most dental plans.
However, Guardian Direct® considers braces or straighteners to be Orthodontic care. The Guardian Direct® top-tier plan does have up to 50% coverage for orthodontic work and devices, which includes Invisalign or straighteners, up to the lifetime maximum benefit. Only people under the age of 19 are eligible for orthodontic coverage and there is a 12 month waiting period for any orthodontic coverage. In order for Invisalign or straighteners to qualify for coverage under the Guardian Direct® top-tier plan they must be applied and monitored by a licensed dentist. Contracted dentists can bill above their contracted fee schedule for optional materials, such as, clear, ceramic or lingual brackets or Invisalign retainers. Our fee schedule allowance is based on standard (metal) braces.
With the Guardian Direct® top-tier plan retainers for dependent children who are under 19 years of age when the braces are placed are covered once per lifetime. If a replacement retainer is necessary that is not covered and you will need to pay for a replacement retainer out of pocket.
Other devices including mouth guards and sleep apnea oral devices are not covered by Guardian Direct® insurance plans. Medical insurance may cover sleep apnea devices if you need one due to medical issues. Mouth guards, even custom ones made by the dentist, are typically not that expensive.
Does dental insurance cover dental bonding?
Dental bonding is another option for fixing your teeth. Dental bonding doesn’t straighten your teeth the way that braces or clear aligners straighten your teeth. But, if you have only a couple of crooked teeth and don’t want to get braces to change the shape of all of your teeth bonding can be used to fix the appearance of crooked teeth¹. Bonding is also often used to repair small chips or cracks in a tooth.
When a dentist bonds your teeth they will take a small piece of resin or resin composite material and shape it to fit your tooth and mouth. It will typically be colored to match your existing teeth so that it looks like it is your tooth. Then the piece of resin is glued over your existing tooth, fixing the shape or modifying the shape of your existing tooth². This process is repeated on however many teeth you need to have bonded, although typically it’s only done on front teeth as a way to make your smile look better. Bonding is a relatively quick and painless procedure and the results will look good for a long time.
Because bonding can be a smart way to help fix a chipped tooth or fix a gap in your teeth or help change the appearance of a tooth you might think that dental insurance would cover it, but in fact most dental insurance plans don’t cover bonding because it’s considered to be a cosmetic procedure. Even though fixing a chipped tooth can stop that tooth from developing infections or cavities bonding is still considered to be cosmetic because it’s primarily used to improve the appearance of teeth not actually change the tooth. Guardian Direct® dental insurance does not cover cosmetic bonding on any of its dental insurance plans.
Sometimes, composite/white fillings are also called dental bonding. Thus, bonding is not covered. Composite fillings are covered as a basic service when needed due to decay .
Are there clear aligners covered by dental insurance?
Clear aligners can be a good alternative to Invisalign and may be more affordable, especially if you have multiple children that need braces or aligners. Are clear aligners covered by dental insurance? Clear aligners like the ones SmileDirect® makes are a popular choice for adults and kids. Guardian Direct® considers clear aligners to be Orthodontic care and not cosmetic dentistry, so the same rules that apply to Invisalign apply to SmileDirect® and other aligners. The Guardian Direct® top-tier plan will covers up to 50% of the cost of SmileDirect clear aligners for dependent children that are younger than 19 when the aligners are placed. And just like with Invisalign the Guardian Direct® top-tier plan will cover SmileDirect aligners after a waiting period of 12 months and will only cover up to 50% of the cost up to the lifetime cap. After the lifetime cap has been met you will be responsible for the full cost of any clear aligners or other orthodontic devices.
Does dental insurance cover sleep apnea dental appliances?
Sleep apnea can be a serious problem that can cause health issues because it causes people to stop breathing at various points throughout the night³. Some people with severe sleep apnea stop breathing hundreds of times each night, which makes it impossible for them to get the restorative sleep that their body needs. Doctors may prescribe a CPAP machine to help people with apnea sleep and make sure they are getting enough air³. But, in less serious cases or when the apnea is caused by a dental issue a dental device that positions the teeth and keeps the airway open can be used to help prevent sleep apnea. If even you need a sleep apnea device to help you get healthy sleep the devices to treat them are usually not covered by any dental insurance. Sleep apnea dental devices are not covered by Guardian Direct® because they are considered to be cosmetic appliances. If you need a sleep apnea machine such as a CPAP machine to help you breathe at night your medical insurance may pay for that. You can also ask your medical insurance to pay for a sleep apnea dental device if your doctor feels that one is necessary.
Are mouth guards covered by dental insurance?
Mouth guards are often used to help protect your teeth while playing sports or to help eliminate snoring at night. Children should always use a mouth guard if they are playing team sports or doing activities like skateboarding or rollerblading. There are two common types of mouth guards: ones that are fitted at home and ones that are custom made by a dentist⁴. The mouth guards that you fit at home are usually called “boil and bite” mouth guards because in order to fit them to your mouth you heat them up in boiling water to soften them and then bite down on them so that the soft material forms to the shape of your mouth. Custom fit dental mouth guards may be more expensive, but they are custom made for your mouth by a dentist so they are usually more comfortable and last longer⁵. Custom fit mouth guards are not covered by Guardian Direct dental insurance.
Are retainers covered by dental insurance & Insights
If you’ve already had your teeth straightened you probably still wear a retainer at night to maintain the position and spacing of your teeth and prevent them from shifting back to their original location. Your children also may need retainers if they have had braces. Retainers are considered to be cosmetic appliances and therefore are not covered by dental insurance, although the Guardian Direct® top-tier dental insurance plan will pay for one retainer per lifetime if needed. Night guards are also not usually covered by insurance.
If you want to learn more about cosmetic dentistry, dental bonding, and what is covered by dental insurance you can browse through the Guardian Direct® library of resources. With articles on everything from dental care and Medicaid to lifestyle tips to help keep your mouth healthy you can get insights on how to keep your smile looking great and to keep your teeth healthy.
Invisalign® is a registered trademark of Align Technology, Inc.
SmileDirect® is a registered trademark of SmileDirectClub.
https://www.mouthhealthy.org/en/az-topics/b/bonding, accessed 2021
https://www.webmd.com/oral-health/guide/dental-bonding, accessed 2021
https://my.clevelandclinic.org/health/treatments/21129-oral-appliance-therapy-for-sleep-apnea, accessed 2021.
Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice.(exp.10/23)