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Does Medicare Cover Invisalign (Or Braces) In 2022?

Rikin Shah | Licensed Life & Health Insurance Agent

Does Medicare Cover Invisalign Or Braces

Who doesn’t want a beautiful smile? Especially these days, when we’re taking more photos than in any prior generation.

But then again, it can be embarrassing to have traditional metal braces for adults.

Enter Invisalign. Let’s look at how this product helps consumers and whether your Medicare coverage will pay for this.

What Is Invisalign?

Invisalign is an orthodontic treatment that uses clear aligners to straighten your teeth. A treatment can take three months and one year, depending on your crooked teeth and your bite structure.

Invisalign is highly popular because the aligners are removable and (almost) invisible.

To be eligible for Invisalign, you must have healthy gums and adequate bone density to hold the aligners.

The Difference Between Invisalign and Braces

While Invisalign is a clear, removable set of aligners custom-fit to your teeth, braces are fixed brackets and wires that are permanently attached to your teeth.

Here are several things to consider when choosing between the two:

  • How severe is your dental misalignment?
  • What is your budget?
  • How important is it that people do not see your braces?
  • Are you willing to wear a retainer?

The Cost of Invisalign

As of 2021, Invisalign begins at $2,800, but all in, the cost averages $4,000 to $5,000.

For those without insurance coverage, Invisalign offers payment plans starting at ~$125 / month.

Does Medicare Cover Invisalign?

If you are on Medicare and want to fix your teeth, you must know what is covered by the government before making any decisions about orthodontic care. This way, you’ll understand why this procedure is not covered.

Let’s take a look at this question for each of the various parts of Medicare.

Original Medicare (Parts A & B)

Unfortunately, Original Medicare does not cover either Invisalign or traditional metal braces. Medicare classifies these as cosmetic procedures; since they are not considered medically necessary, Medicare will not pay for braces or Invisalign.

For that matter, Medicare Parts A & B do not cover routine dental care or any orthodontic procedure.

The only exception would be a restorative orthodontic procedure that seeks to fix an issue that has resulted from an accident or disease. In this case, Medicare may consider related orthodontic procedures to be medically necessary.

Medicare Advantage (Part C)

Private insurance companies sell Medicare Advantage plans to eligible Medicare recipients as an alternate way to get your Medicare Part A and Part B benefits.

What makes Medicare Advantage plans attractive to many Medicare recipients is that these private insurance providers bundle additional benefits (e.g., dental benefits) and coverage with the Part A & B coverage they are required to provide.

Check your Medicare Advantage plan’s coverage details to see if you have dental insurance built into your plan. If not, your plan may provide you the option of enrolling in one of several dental insurance plans. In either of these cases, you’ll be covered for far more dental services than you would be under Original Medicare.

Additional Medicare Coverage

The last two categories of Medicare coverage are Medicare Part D and Medigap (Medicare Supplement Insurance). Unfortunately, neither of these provides orthodontic coverage.

Medicare plans under Part D cover prescription drugs only. And Medigap plans cover your Part A and Part B out-of-pocket expenses (deductibles and co-payments); they do not cover additional services beyond those covered by Original Medicare.

Invisalign Coverage FAQs

Medicare does not cover Invisalign (or traditional braces, for that matter). Medicare does not consider these procedures medically necessary, and therefore, will not pay for them.

Conclusion

If you’re on Medicare, it may be difficult for you to cover the cost of Invisalign. The average price is $5,000, which can put a dent in your budget if you are not financially secure.

However, there are some services that Medicare does cover, such as cleaning and restoration. This can still help you fix your teeth at a significantly lower price than if Medicare covered Invisalign.

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