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Your dental insurance covered your last cleaning and the filling before that. You might’ve even used it for a root canal last year. So it should cover your teeth straightening treatment too, right? Not always. Getting coverage for your orthodontic treatment depends on a few different factors, primarily whether or not your benefits include teledentistry coverage.
We’ll start with the good news: depending on your specific insurance plan, you might receive coverage for a portion of your dentist’s price for Candid. But there’s also a chance that your insurer will deny your claim (even if you have orthodontic benefits). How can you find out? Read this guide. It will explain the insurance policies and procedures your dentist might have for Candid clear aligner treatment.
Does Standard Insurance Cover Orthodontics?
How Do I Get Coverage?
How Do I Claim My Benefits?
Other Ways To Manage Costs
What About HSAs and FSAs?
Does Standard Health Insurance Cover Orthodontics?
In short: no, it doesn’t. And this is normally the case whether you’re considering a traditional orthodontic treatment option like braces, Invisalign, or Candid, or an at-home aligner service like Byte or SmileDirectClub. Health insurance plans are separate from dental insurance plans, so they’ll usually only cover serious, medically necessary procedures on the face and jaw. Standard health insurance does not cover routine cleanings, fillings, and orthodontic work.
In many cases, insurance providers consider teeth straightening a cosmetic procedure, which generally isn’t covered under most plans. When you have an initial consultation with a local dentist, they can give you more information about your condition and whether or not it might be considered a cosmetic correction.
What If I Have Dental Insurance?
Dental insurance can be paired with standard health insurance to cover preventative care like semiannual cleanings and other routine procedures (fillings, root canals, etc.).
Sometimes these plans will include orthodontic benefits as well, and that’s where you should focus. Orthodontic benefits often come with a lifetime coverage limit rather than an annual limit. So, if your teeth require extensive or long-term treatment, you might run out. And there are a few other complications:
On average, orthodontic benefits could cover 50% of the treatment cost up to your lifetime maximum, and a deductible could also apply.
Some dental benefits have a waiting period, which means you’ll need to wait for a predetermined amount of time after enrolling with your plan before using them (this could be 3-6 months for minor procedures and 6-12 for major ones).
Other plans have age restrictions. For example, some only cover orthodontic treatment for dependents up to age 19.
You should be aware of the distinction between “in-network” and “out-of-network” coverage. Treatment by out-of-network providers can be subject to higher deductibles, and less coverage. Check with your insurance company to see if the dentist administering your Candid treatment is in or out of their network.
The moral of the story is that you shouldn’t simply assume that your dental insurance will cover Candid — or any orthodontic treatment, for that matter. But you should still familiarize yourself with your plan’s details and contact your provider to see if you’re eligible for coverage.
Is Candid Covered Differently Than Braces or Invisalign?
Next scenario: you have dental insurance and orthodontic benefits. In this case, there’s a chance you could receive insurance coverage, but it all depends on your specific plan and dentist.
You’ll receive your Candid clear aligners in person from one of their 200+ providers, and even though your dentist will monitor your progress remotely for part of your treatment, many insurance providers will classify it under insurance code D8090 — the same as Invisalign. That means that they’ll often cover a portion of your treatment, although that varies based on your plan and whether or not you’ve already used your orthodontic benefits for other treatments.
However, some providers only place treatments in this category if they involve routine office visits, in which case they may not cover Candid. The only way to know for sure is to speak with your dentist and contact your insurance provider.
Orthodontic coverage isn’t something you need to buy separately — it’s simply included in certain plans. There are two ways to get enrolled in a suitable dental plan: through your employer, or by purchasing an individual plan.
How Do I Get Orthodontic Benefits?
About half of all adults in the US receive dental insurance through their employer (or their spouse’s employer). There are a couple of advantages to enrolling in dental insurance through an employer plan. For one thing, insurance premiums get deducted directly from your wages before tax, reducing what you owe in taxes. For another, employers often contribute toward the cost of their plans, which results in lower premiums.
Employer-sponsored dental plans have their drawbacks though. First, you’re limited to the plan options offered by your employer. This can be especially problematic if you’re interested in braces or clear aligners, as many dental insurance plans do not cover orthodontics, or offer very limited coverage. Second, employer-sponsored dental plans are often bundled together with health plans, so you may need to wait for an “open enrollment” period to modify your plan. Lastly, many companies simply don’t offer dental insurance at all.
Fortunately, even if you receive health and/or dental coverage through your employer, you can always invest in an individual plan that covers orthodontics, too. And unlike buying standard health insurance, you don’t have to wait for an open enrollment period to purchase an individual dental/orthodontics plan — you can enroll at any time of the year!
How Do I Claim My Benefits?
You don’t really have to do anything. One of the nice parts about receiving treatment through a dentist’s office is that they will file insurance claims for you, as long as your dentist accepts your insurance.
Here’s how it works: Your dentist’s office will send a claim to your insurance provider, who will review it and compare the treatments provided to those covered by your plan. If they provide coverage, they will send back a payment, which your dentist will deduct from your bill. Then, the office will send you an “Explanation of Benefits,” which outlines the services and insurance coverage, followed by a final bill.
Compare your bill with your Explanation of Benefits document and make sure that everything lines up. And if you have any questions, reach out to the insurance company for clarification.
Other Ways to Manage Orthodontic Costs
If your plan doesn’t include orthodontic benefits and you don’t have any other options, you might be out of luck. But don’t worry, there are still ways to make Candid’s price more accessible.
Dental Discount Plans: Certain providers may also offer dental discount plans (or dental savings plans). These are not insurance plans. Rather, they’re like a subscription where you pay a monthly or annual fee and receive discounts on certain procedures or designated dentists. Sometimes these plans include orthodontic treatments.
Shop around: Different dentists have different rates. And if you live near multiple Candid providers, there’s nothing wrong with getting multiple estimates to compare prices. Just make sure that the dentist you choose is in your insurance provider’s network or you might not receive coverage.
Look into financing: Most dental and orthodontic offices offer some type of financing plan. Some provide in-house payment plans, while others partner with third-party companies like CareCredit and BeWell. Most of these plans include interest, so you’ll end up paying a little more in the long run. When you make your initial office visit, ask your dentist for details on their financing options.
Consider online clear aligners: If you like the appearance of clear aligners but Candid’s price seems a little steep, you might consider getting clear aligners from a provider like Byte, AlignerCo, or SmileDirectClub. They’re a less expensive alternative that can treat mild-to-moderate cases of crowding, spacing, and even some bite issues.
What About HSAs and FSAs?
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs) both allow you to contribute pretax income to your medical expenses. They’re an option for many employer health plans (HSAs require a higher-deductible plan, though), and they’re also a viable payment option for your Candid treatment, as long as your dentist accepts them.
If so, you can pay for your treatment directly from one of these accounts, whether or not you’ve received any insurance coverage. If your account is linked to a debit card, just use it like you would any other card. Otherwise, reach out to your dentist’s office for assistance.
If you have an FSA, remember that they have a time limit, since you can’t roll over funds from year to year like you can with an HSA. Make sure to use your funds before they expire!
If you’re considering Candid treatment from a local dentist, don’t rule out insurance coverage! Customers receive reimbursements more often than you might think. While Candid doesn’t have as many in-network partnerships as some competitors, you can still significantly reduce your treatment expenses.
Of course, it all depends on your specific provider and plan, so check with the insurance company and your dentist before you do anything else. Once you’ve got that squared away, you’ll have a better sense of your total Candid price and one step closer to beginning your smile journey.
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Pursuing orthodontic treatment as an adult can feel stressful and overwhelming. At Smile Prep, we strive to make the process as easy as possible for our readers. Our guides and reviews cut the fluff and give you the information necessary to take a confident step toward your smile goals.
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Does Standard Insurance Cover Orthodontics?
Is Candid Covered Differently?
How Do I Get Coverage?
How Do I Claim My Benefits?
Other Ways To Manage Costs
What About HSAs and FSAs?
Concerned About the Cost of Orthodontic Treatment?
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