Do Health Funds Cover Invisalign?: Straighten Your Smile Without Breaking the Bank

talk between dentist and her patient

Invisalign is a popular orthodontic treatment that uses clear, removable aligners to straighten teeth. It is a great alternative to traditional metal braces for those who want a more discreet orthodontic option.

One of the most common questions people have about Invisalign is whether it is covered by health funds. The answer is not straightforward, as coverage can vary depending on the specific health fund and policy. Some health funds may offer partial coverage, while others may not cover Invisalign at all.

In this blog post, we will explore the different factors that determine whether Invisalign is covered by health funds and what patients can expect when it comes to financing their treatment.

  • Medicare doesn’t cover payment for Invisalign, but private health funds may offer cover depending on policy details and level of cover.

  • Not all health funds cover Invisalign, and cover is subject to waiting periods and annual limits.

  • To find out if your health fund covers Invisalign, contact your health fund provider directly.

  • To claim Invisalign treatment from your health fund, you must provide an itemised receipt, health fund membership details, a treatment plan, and a written referral from your dentist.

  • Reimbursement for Invisalign treatment from your health fund can take several weeks, depending on factors like the level of dental cover, the complexity of the claim, and the current workload of your health fund.

  • If you don’t have health fund cover for Invisalign treatment, you can pay for the treatments out of pocket. Health fund covers for Invisalign varies depending on the case’s complexity and duration.

  • Some dentists offer payment plans or financing options to help make the treatment more affordable.

  • Even if you have cover from your health funds for Invisalign treatment, you must still pay out-of-pocket expenses like gap fees and miscellaneous treatment costs.

What is Invisalign?

Invisalign is a type of clear orthodontic aligner used to straighten teeth. This removable appliance is an alternative to traditional metal braces and is often preferred by individuals who want a more discreet and comfortable teeth-straightening treatment.

Invisalign aligners are custom-made for each individual and are made of a transparent and flexible plastic material that fits over the teeth. They are virtually invisible and can be removed when needed.

Invisalign treatment involves a series of aligners that gradually shift your teeth to the desired position. Unlike traditional braces, each set of aligners is worn 20-22 hours a day for two weeks before it is replaced with the next set in the series. The total length of treatment depends on the severity of the orthodontic problem being resolved. In most cases, the average treatment period of Invisalign can range between 12-18 months. 

Do Health Funds Cover Invisalign?

Some private health funds in Australia offer cover for Invisalign treatment. However, the amount covered can vary depending on the fund and the level of cover you’ve chosen. Not all health funds cover Invisalign, and dental cover is subject to waiting periods and yearly limits.

To find out if your health funds cover Invisalign treatment and what level of cover you’re eligible for, contact your health fund provider directly. They can provide information about your cover options and help you understand any out-of-pocket expenses you may need to pay.

What Documentation Do I Need to Provide to My Health Fund to Claim Invisalign Treatment?

To claim Invisalign treatment from your health fund, you will need to provide the following documentation:

  • Itemised receipt:
    You will need a receipt from your dentist or dental clinic showing the service date, the patient’s name, and the treatment cost.

  • Health fund membership details:
    You must provide your health fund membership number and details, including your name, date of birth, and level of dental cover you’ve chosen.

  • Invisalign treatment plan:
    Your dentist should provide a detailed treatment plan outlining the course of treatment, expected duration of treatment, and associated costs.

  • Written referral:
    In some cases, you may need a written referral from your dentist before beginning Invisalign treatment.

Depending on your health fund and level of dental cover, you may need to have served any applicable waiting periods before you can claim Invisalign treatment.

Check with your health fund to understand their requirements for claiming cover for Invisalign treatment. Some health funds may have additional requirements for claims, while others may require pre-authorisation before the treatment process begins.

How Long Does It Take to Receive Reimbursement for Invisalign Treatment from My Health Fund?

The time it takes to receive reimbursement for Invisalign treatment from your health fund can vary depending on several factors. In general, receiving reimbursement after submitting a claim can take several weeks.

The time it takes for your health fund to process your claim can depend on several factors, including the level of dental cover, the complexity of the claim, and the current workload of the health fund.

It’s important to remember that some health funds may have waiting periods before you can claim reimbursement. Some may have annual limits on the number of benefits you can receive for orthodontic treatment.

If you’re unsure about the process or timeline for receiving reimbursement for Invisalign treatment from your health fund, contact your provider to ask for information about their claims process and any relevant waiting periods or limits.

Can I Get Invisalign Treatment without Health Fund Coverage?

Yes, you can get Invisalign treatment without dental cover. You may choose to pay for this treatment out of pocket.

The cost of Invisalign treatment varies depending on several factors. This includes the complexity of the case and the duration of the treatment.

If you’re interested in getting Invisalign treatment but are concerned about the cost, some dentists may offer payment plans or financing options to help make the treatment more affordable. Discussing these options with your dentist during your consultation is a good idea.

Remember that Invisalign treatment is a long-term investment, and the additional benefits of having straighter teeth can significantly affect your oral health. It can make brushing and flossing easier, reducing the risk of tooth decay and gum disease. Straighter teeth can also enhance one’s appearance, boost their self-confidence and improve their quality of life. These benefits make Invisalign treatment worth considering even if you don’t have health fund cover for this treatment. 

Will I Need to Pay Any Out-Of-Pocket Expenses for Invisalign Treatment?

Even if you have health fund cover, you’ll likely need to pay out-of-pocket expenses for Invisalign treatment. Some of the common out-of-pocket expenses you may need to pay include:

  • Gap fees:
    If your health fund does not cover the full cost of your Invisalign treatment, you’ll need to pay a gap fee to cover the difference.

  • Pre-treatment costs:
    Depending on your case, you may need to pay for pre-treatment procedures, such as x-rays or dental cleaning, before beginning Invisalign treatment.

  • Additional treatment costs:
    If your case is particularly complex or requires additional treatment like tooth extractions or other dental procedures, you may need to pay additional out-of-pocket expenses.

It’s important to discuss any potential out-of-pocket expenses with your orthodontist before beginning Invisalign treatment. They can provide you with a detailed dental plan and an estimate of the costs involved so that you can make an informed decision about your treatment options.

Can I Claim Invisalign Treatment Through Medicare?

Medicare in Australia does not cover Invisalign treatment, as it’s considered cosmetic or elective treatment. Medicare only covers dental treatments that are medically necessary and performed in a hospital setting.

However, there are limited circumstances in which Medicare may provide benefits for orthodontic treatment. For example, Medicare may provide some benefits if the treatment is needed due to a congenital abnormality or traumatic injury. In these cases, you must meet specific eligibility criteria and have the treatment performed in the hospital.

It’s important to note that Medicare cover for orthodontic treatment is limited, and even in cases where the benefits may be available, they may not cover the full cost of the treatment.

How Much Does Medicare Cover for Invisalign Treatment?

Medicare generally does not cover orthodontic treatment plans, including Invisalign treatment costs. Patients seeking this treatment must pay for it out-of-pocket or through private health funds.

It’s important to note that private health fund cover for orthodontic treatment can vary widely depending on the provider and level of cover selected. Patients should carefully review their policy and consult their provider to determine what benefits may be available within their orthodontic limit.

How Much Do Invisalign Cost

The cost of Invisalign treatment varies depending on several factors. This includes the following:

  • The complexity of the case is an important factor that influences the cost of Invisalign treatment because more complex cases require more aligners, additional treatment time, and regular appointments. Cases that require more extensive work, such as those with significant misalignments or bite issues, will require more aligners and longer treatment times than cases with minor misalignments.

  • The location of a dental practice can affect the cost of Invisalign for a few reasons:

    • The cost of living can be higher in certain areas, which can increase the overhead costs for the dental practice, including rent, utilities, and salaries for staff. These increased costs are passed on to patients in the form of higher treatment fees.

    • Some areas may have a higher demand for Invisalign treatment, resulting in higher fees due to increased competition among dental practices. In these areas, practices may charge more for Invisalign treatment because more patients are willing to pay for the service.

  • The dental providers’ experience and expertise influence the cost of Invisalign. Highly skilled and experienced providers may command higher fees for their services, as they can provide a higher level of care and achieve better patient outcomes.

The average cost of Invisalign treatment is $6000-9000 for a full course of treatment. However, this is just an estimated price range. Consult your dentist so they can give you a more accurate cost of treatment.

What Other Payment Options Are Available for Invisalign?

Health funds

Here are options for health funds for Invisalign that AP Dental offers:

  • Hbf member choice awards its members exclusive benefits to suit their needs. Patients have the flexibility to mix and match extra products. HBF offers five different extras plans which cover preventive and restorative dental treatments and major dental procedures, including dental implants and orthodontics. However, depending on the dental plan, annual limits may apply to some treatments.

  • BUPA health insurance offers extras tailored to suit your needs. Members can enjoy a 60-100% discount on most general dental services. Patients can also choose how much they want to spend on claims annually based on their preferences.

  • Medibank is an Australian health fund offering customers medical cover plans. Among their extras plans, they also provide dental cover. The extent of dental cover depends on the procedures needed and the benefits of the chosen extras plan.

  • HCF is a not-for-profit insurer that aims to improve the health and well-being of its members. They offer more benefits than the average industry and are committed to helping you lead active and healthy lifestyles.

  • AHM covers a range of services, from minor treatments to major dental services, like complicated oral surgeries. Claim filing is simple and can be done through the AHM app or card.

Please note that not all orthodontic benefits provided by private health funds are equal. We suggest contacting your provider to see if your policy has yearly or lifetime limits.

Payment plans

You can split the Invisalign treatment costs with these payment plans:

  • ZIP is a flexible payment option at AP Dental, allowing patients to pay for their dental treatment conveniently and securely. It’s a great solution for individuals who cannot afford large upfront payments for dental care. ZIP offers a range of payment plans to suit your financial needs. With ZIP Pay, patients can pay for treatment costs up to $1000 using a pay-later option. For treatment costs exceeding $1000, ZIP Money can be used. This means you can access dental care without worrying about the financial burden.

  • Afterpay makes affordable weekly payments for your dental treatments while enjoying the benefits of a beautiful new smile. Afterpay is available through their app and can cover transactions over $35 in most establishments. With the timely payment of instalments, the spending limit increases, making it a great option for managing major dental treatment costs.

  • Humm is a financial platform that offers buy-now-pay-later payment plans to help people pay for dental care. The application process is quick, and approvals are provided instantly if qualifications are met. Two payment plans are available, Little Things and Big Things. Little Things offer immediate approval for minor procedures, while Big Things offer longer repayment terms for more expensive major dental treatments.

  • Supercare offers a solution to families who don’t have sufficient funds or private health funds to cover dental treatments. At least one family member needs Superannuation funds to be eligible for their services. Supercare helps families access dental and orthodontic treatments recommended by their chosen specialist. The ATO conducts the final assessment of the application request.

Government schemes

Take advantage of these government schemes to subsidise payment for Invisalign:

  • Child Dental Benefits Schedule (CBDS) is a government-funded program designed to provide basic dental care to children and improve population-wide oral health. Available to children 0-17 enrolled in Medicare, CBDS has a yearly limit of $1026, renewed every two years.

  • DVA Card Holders deserve access to quality health care, including dental care. With the DVA health card, veterans can choose any provider for their dental treatments. The Veteran White Card covers procedures for service-related conditions, while the Veteran Gold Card covers all medically necessary dental services.

Final Thoughts

While Medicare doesn’t cover Invisalign treatment, private health funds may subsidise some of the cost depending on your policy details. If you don’t have health fund cover for Invisalign treatment, you can choose to pay for the treatment out-of-pocket.

You must check with your health fund provider to understand their requirements for claiming Invisalign treatment, including any waiting periods or annual limits.

Looking for a straighter smile? Look no further than AP Dental! Our experienced dentists and staff can advise you on Invisalign treatment and payment options.

What are you waiting for? Contact AP Dental to schedule your initial consultation and start your journey towards a straighter, healthier smile!

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Jigisha Shah

Principal Dentist

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At AP Dental, we are proud to offer a wide range of dental services to meet the needs of our patients. From professional cleanings and dental fillings to more complex procedures, we are here to help you maintain a brighter, healthier smile. Book your appointment today and see the difference our team can make.

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