As Dr. Babak, a cosmetic dentist serving Los Angeles and surrounding areas, I’ve answered this question countless times for patients seeking clarity on their insurance coverage for orthodontic treatment.
Let me break down everything you need to know about Cigna dental coverage for braces—both for adults seeking cosmetic improvements and those needing emergency orthodontic care.
Cigna Dental Coverage for Braces: The Bottom Line
Cigna does cover braces, but the extent of coverage varies significantly depending on your specific plan. Most Cigna Dental plans offer partial coverage for orthodontic treatment, typically covering between 50-80% of costs after deductibles.
According to the American Dental Association, only about 39% of dental insurance plans provide comprehensive orthodontic coverage for adults, while nearly 86% offer coverage for children under 18.
| Cigna Plan Type | Adult Orthodontic Coverage | Coverage Percentage | Lifetime Maximum |
|---|---|---|---|
| Cigna Dental 1000 | Limited or None | 0-50% | $0-$1,000 |
| Cigna Dental 1500 | Partial | 50-60% | $1,000-$1,500 |
| Cigna Dental Orthodontia | Yes | 50-80% | $1,000-$2,500 |
| Cigna Dental Preventive | None | 0% | $0 |
Types of Cigna Dental Plans That Cover Braces
Not all Cigna dental plans are created equal when it comes to orthodontic coverage:
Cigna Dental HMO Plans
These plans typically provide the most comprehensive orthodontic coverage but require you to see in-network providers like our practice near Beverly Hills.
The average discount for braces with Cigna DHMO plans ranges from 25-45% off regular pricing.
Cigna Dental PPO Plans
These offer more flexibility in choosing providers but may have lower coverage percentages for orthodontic treatment.
Most PPO plans cover around 50% of orthodontic costs up to a lifetime maximum that typically ranges from $1,000-$2,500.
Cigna Dental Discount Plans
These aren’t true insurance but provide discounted rates on various dental services, including braces. Discounts typically range from 15-30% off standard prices.
Adult vs. Child Coverage: What’s the Difference?
Many patients are surprised to learn that adult orthodontic coverage differs significantly from coverage for children:
- 72% of Cigna plans that cover orthodontics have age restrictions or different coverage levels for adults vs. children
- Adult coverage typically has lower lifetime maximums
- Some plans only cover braces deemed “medically necessary” for adults
As someone who specializes in adult cosmetic dentistry in Los Angeles, I can tell you that insurance companies often consider adult braces “cosmetic” rather than medically necessary.
What Counts as “Medically Necessary” Braces?
For Cigna to consider braces medically necessary (which increases coverage potential), you typically need:
- Severe bite issues affecting function
- Speech impediments caused by dental alignment
- Difficulty chewing or eating
- Jaw pain or TMJ disorders related to alignment
According to the Journal of the American Dental Association, approximately 38% of adult orthodontic cases qualify as medically necessary.
Typical Costs for Braces With and Without Cigna Coverage
Let’s break down the actual costs you might face in Los Angeles:
Traditional Metal Braces
- Average cost without insurance: $3,000-$7,000
- With Cigna coverage: $1,500-$3,500 out-of-pocket
Ceramic Braces
- Average cost without insurance: $4,000-$8,000
- With Cigna coverage: $2,000-$4,000 out-of-pocket
Invisalign
- Average cost without insurance: $4,500-$9,000
- With Cigna coverage: $2,250-$4,500 out-of-pocket
How to Check Your Specific Cigna Coverage
Before scheduling your consultation at our Westwood office, I recommend:
- Call Cigna directly using the number on your insurance card
- Ask specifically about:
- Adult orthodontic coverage percentage
- Lifetime maximum benefit
- Any waiting periods
- In-network provider requirements
- Pre-authorization requirements
Alternatively, our front office team can verify your benefits for you—just have your insurance information ready when you call.
Alternative Payment Options When Cigna Coverage Falls Short
If your Cigna plan doesn’t provide adequate coverage, don’t worry. At our practice, we offer:
- 0% interest payment plans for up to 24 months
- 10-15% discount for paying in full upfront
- CareCredit financing options
- HSA/FSA acceptance
- Seasonal specials (currently offering $500 off Invisalign for new patients)
Why Choose Our Practice for Braces Despite Insurance Limitations
Even with limited insurance coverage, there are compelling reasons to choose our practice for your orthodontic needs:
- Same-day emergency appointments available
- Evening and weekend hours to accommodate busy schedules
- Comprehensive 3D imaging included in consultation (a $350 value)
- Combined experience of over 25 years in cosmetic dentistry
- Serving patients throughout Los Angeles, from Venice Beach to Silver Lake
How the Braces Process Works at Our Practice
When you choose us for orthodontic treatment, here’s what to expect:
- Initial Consultation: Comprehensive examination and discussion of goals
- Insurance Verification: Our team confirms your exact Cigna benefits
- Treatment Planning: Custom orthodontic plan development
- Financial Discussion: Review of costs, insurance coverage, and payment options
- Treatment Initiation: Begin your journey to a straighter smile
- Regular Adjustments: Scheduled appointments to ensure progress
- Completion: Removal of braces and retainer fitting
FAQs About Cigna Dental Coverage for Braces
Does Cigna cover Invisalign the same as traditional braces?
Most Cigna plans that cover orthodontics provide the same coverage percentage for Invisalign as traditional braces, but coverage is limited to the plan’s lifetime maximum regardless of the type of orthodontic treatment.
Is there a waiting period for orthodontic coverage with Cigna?
Yes, many Cigna plans have a 12-month waiting period before orthodontic benefits become available. Our team can help verify if you’ve satisfied this waiting period.
Can I use my HSA or FSA to pay for braces?
Absolutely! Orthodontic treatment is a qualified medical expense, allowing you to use pre-tax dollars from your HSA or FSA to cover costs not covered by your Cigna plan.
Do I need a referral to see an orthodontist with Cigna Dental?
With Cigna DHMO plans, you typically need a referral from your primary care dentist. With Cigna DPPO plans, referrals are generally not required, but treatment may need pre-authorization.
What if I switch insurance during orthodontic treatment?
This can be complicated. If you switch from one Cigna plan to another, benefits may transfer. If you switch insurance companies entirely, you may lose remaining benefits and need to negotiate coverage with the new provider.
Making the Right Choice for Your Smile and Budget
Navigating insurance coverage for adult braces can be challenging, but don’t let limited coverage deter you from getting the smile you deserve.
At our practice serving the Los Angeles area, we’re committed to helping patients maximize their insurance benefits while providing flexible payment options for any remaining costs.
Whether you’re dealing with crowded teeth, spacing issues, or bite problems, we offer same-day appointments for consultations and emergencies.
Does Cigna dental cover braces? The answer is yes—with caveats and limitations. But with the right dental partner, you can navigate those limitations to achieve the smile you’ve always wanted without breaking the bank.
Book your consultation today: https://ladentalexperts.setmore.com
Sources:
- American Dental Association Statistical Report on Dental Benefits, 2023: https://www.ada.org/
- Journal of the American Dental Association (JADA), Vol. 154, Issue 3: https://jada.ada.org
- WebMD Dental Insurance Guide: https://www.webmd.com/
- Cigna Dental Benefits Overview: https://www.cigna.com/