Does Aetna Cover Invisalign? A Clear Look at Your Orthodontic Benefits

Coverage options vary, but Invisalign's official cost and insurance page confirms that dental insurance can contribute up to $3,000 toward treatment in some cases.

However, not every policy includes orthodontics, and not every insurer treats Invisalign the same.

This article breaks down exactly how Aetna handles Invisalign coverage, what’s typically included, what to look for in your policy, and how to make the most of your orthodontic benefits.

Does Aetna Dental Cover Invisalign?

Just because Aetna administers your dental insurance doesn't automatically mean you’re covered for Invisalign. There’s no substitute for a careful review of your plan’s Summary of Benefits.

Several clauses determine whether Invisalign qualifies for reimbursement:

• Non-covered service: If the plan identifies orthodontics as a non-covered service or expense, there will be zero coverage for Invisalign. This clause removes orthodontic benefits entirely, making coverage non-negotiable regardless of medical necessity or provider recommendation.

• Limitations and exclusions: Many Aetna dental plans restrict orthodontic coverage to individuals under a certain age, often 19. Even when Invisalign is named as a covered benefit, this type of age restriction will block coverage for adults. The benefit exists, but it’s off-limits once you age out.

Aetna may still reimburse costs for Invisalign services performed by out-of-network providers, though reimbursement levels could differ. The insurer evaluates claims for Invisalign under the same orthodontic rules, regardless of who performs the treatment.

Curious whether your current plan covers Invisalign?

Exploring Aetna Dental Plans: What They Offer for Orthodontic Treatment

Aetna provides multiple tiers of dental insurance, each structured to cater to different needs and budgets. While coverage for orthodontic treatment like Invisalign isn’t guaranteed across all plans, several types offer specific benefits that can reduce the cost of aligner therapy.

• PPO (Preferred Provider Organization): This flexible plan allows members to visit any licensed dentist, though choosing an in-network provider typically results in higher reimbursement rates. Many PPO plans include optional orthodontic benefits, which may cover a percentage of Invisalign costs after meeting plan-specific requirements.

• DMO (Dental Maintenance Organization): Under this structure, members must select a primary care dentist from Aetna’s network and require referrals for specialty care. DMO plans often have lower premiums and fixed co-payments, but orthodontic coverage—when available—can be more restrictive, and Invisalign may not be fully included.

• Indemnity Plans: These traditional plans reimburse members for dental care based on a fee schedule, regardless of the provider network. While less common, some indemnity policies include orthodontic riders that can be applied toward Invisalign, though reimbursement caps still apply.

Key Differences Between Aetna Plan Types and How They Affect Orthodontic Coverage

PPO plans typically offer broader access to Invisalign in exchange for higher premiums and shared costs. DMO plans impose stricter networks and referral requirements, and although costs are predictable, coverage options are narrower.

Indemnity plans provide the most freedom in choosing providers, but benefits are often limited by fixed reimbursement schedules and lifetime maximums.

For example, with a PPO plan, Aetna might cover up to 50% of orthodontic expenses after the deductible is met, while in a DMO plan, coverage might require the treatment to be deemed medically necessary and pre-approved through in-network referrals only.

Terms to Know: Deductible, Co-pay, Co-insurance, Lifetime Max

• Deductible: The amount the policyholder must pay out-of-pocket before plan benefits begin. To access orthodontic coverage, this must first be satisfied annually or per treatment phase, depending on the plan.

• Co-pay: A fixed fee paid at the time of service; DMO plans often use co-pays instead of percentage-based charges, offering predictable costs for eligible procedures.

  Co-insurance: The percentage of treatment costs the insured shares with the insurance provider after the deductible is met; many Aetna PPO plans require 50% co-insurance for orthodontic services.

• Lifetime Maximum: The cap on orthodontic benefits paid by the insurer over a member’s lifetime, which often ranges from $1,000 to $2,500, depending on the plan.

  
  

What You’ll Pay: The Real Cost of Orthodontics Before Insurance

Before factoring in any insurance benefits from Aetna or another dental plan, the cost of orthodontic treatment like Invisalign varies widely across the U.S. These price differences depend heavily on the region’s cost of living, the provider's expertise, and the complexity of the dental adjustment required. Let’s break down the numbers.

Invisalign: National Average Pricing Range

• $4,000–$6,000: This is the typical range if you're visiting a dentist or orthodontist in a lower cost-of-living area. Think suburban cities with a lower overhead for dental practices, where providers charge less due to market standards and operating expenses.

• $6,000–$8,000: In major metro areas—like New York, San Francisco, or Los Angeles—expect to pay toward the higher end of the spectrum. Dentists in these cities often face higher rent, salaries, and equipment costs, and pricing reflects that.

What influences where your treatment falls on the spectrum? A few key elements drive the cost.

• Geographic location: The ZIP code of your provider’s office often shapes the base fee. In high-demand urban regions, this number climbs.

• Provider’s experience: Orthodontists with advanced certifications, a reputation for complex cases, or a designated “Top 1% Invisalign Provider” status often charge more.

• Treatment length and complexity: Mild cosmetic adjustments may require fewer aligners, leading to lower costs. More complex bite corrections usually demand longer timelines and additional trays, increasing the fee.

Run a quick search for Invisalign providers in your city.

Are most estimates coming in closer to $5,000 or tipping past $7,500? That alone gives a starting point for your budget. And knowing this range will help clarify how much Aetna may save you once insurance coverage kicks in.

Finding the Right Aetna Dentist for Orthodontic Coverage

Before booking a consultation with an orthodontist, check your Aetna dental plan type. Aetna offers two primary plan structures: Dental Maintenance Organization (DMO) and Preferred Provider Organization (PPO). Each comes with different rules about provider access and referral requirements.

• DMO plans require you to select a primary care dentist and get referrals for specialists. Coverage applies only when you see in-network providers.

• PPO plans allow more flexibility. You can visit any licensed dentist, but staying in-network reduces your costs significantly.

Once you confirm your plan's coverage for orthodontics, your next step is to locate an appropriate provider within Aetna’s network who offers Invisalign treatment.

Use Open and Affordable to Locate In-Network Orthodontists in Colorado

Open and Affordable Dental’s online directory is the most efficient tool for searching in-network braces and Invisalign providers. Select the location, select the languages spoken, then filter for “Services” and narrow your results to Clear Aligners professionals.

Weigh Convenience, Specialization, and Cost

Choose an orthodontist based on three factors that directly affect your experience and results:

• Proximity: Invisalign treatment requires periodic visits. A conveniently located dentist reduces scheduling friction and missed appointments.

• Invisalign certification: Not all orthodontists are Invisalign providers. Look for dentists with “Invisalign Gold,” “Platinum,” or “Diamond” designations—these reflect case volume and experience.

• Cost structure: In-network providers accept Aetna's negotiated fees, which significantly lowers your out-of-pocket responsibility. Ask for an itemized estimate based on your specific Aetna plan before committing.

Next Step: Schedule a Consultation

Once you’ve selected a preferred provider, schedule a consultation to determine if you’re a candidate for Invisalign and to receive a detailed treatment plan. Bring your insurance card, and confirm the office is prepared to process claims through Aetna. That proactive step avoids surprise billing later on.

Filing Claims for Invisalign with Aetna: Step-by-Step

Choosing an orthodontist who isn't in Aetna’s network triggers a few extra steps for reimbursement. Here’s exactly how to file a claim yourself:

• Download Aetna’s dental claim form. You can find this on the Aetna member portal by logging in and navigating to the dental coverage section.

• Complete all required fields. This includes your plan number, member ID, the provider's name and TIN (Tax Identification Number), and the date Invisalign treatment began.

• Attach the itemized bill or invoice. This should clearly show procedure codes, charges, and dates of service. Invisalign’s billing usually uses CDT code D8080 (comprehensive orthodontic treatment of the adolescent dentition) or D8090 (for adults), depending on age.

• Mail your packet to the claim address listed on your Aetna insurance card. Digital submission via the member portal is also available for some plans.

Processing typically takes 15–30 business days. Aetna will either reimburse you directly or apply the approved amount to your deductible and send you an Explanation of Benefits (EOB).

Supporting Documents That Matter

No claim will move forward without documentation. These are the key pieces Aetna uses to evaluate an Invisalign claim:

• Pre-authorization approval letter: If your orthodontist submitted a pre-treatment estimate and received approval, include this document. It signals Aetna has already committed to a coverage amount.

• Treatment plan estimate: This should come from your provider and outline the full Invisalign timeline, total cost, and frequency of aligner adjustments or replacement trays.

• Orthodontic records: These may include X-rays, photos, and molds that demonstrate medical necessity—especially relevant if your plan excludes cosmetic procedures that aren't dentist-determined as functionally needed.

If the Claim Is Denied or Partially Approved

Aetna doesn’t always approve the full Invisalign cost. When that happens, respond with documentation. Here's how to handle post-decision adjustments:

• Review the Explanation of Benefits (EOB): This document shows why a claim was rejected or only partially paid. Look for specific codes and language like “not medically necessary” or “outside coverage limits.”

• Submit an appeal: Include a letter of medical necessity from your orthodontist, updated X-rays or dental impressions, and any new or omitted treatment details.

• Follow Aetna’s formal appeal process: Deadlines matter. You typically have 180 days from the denial date. Send your full appeal packet to the address listed under “appeals” in your EOB.