Does Delta Dental Cover Braces? A Comprehensive Guide for 2024

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Does Delta Dental Cover Braces

Navigating the complex world of dental insurance can be overwhelming, especially when it comes to understanding coverage for orthodontic treatments like braces. As a leading provider of dental benefits in the United States, Delta Dental offers a range of plans with varying levels of coverage for braces. In this comprehensive guide, we’ll dive deep into Delta Dental’s policies regarding braces coverage, helping you make informed decisions about your or your child’s orthodontic treatment in 2024.

Understanding Delta Dental’s Plans

Delta Dental provides several types of dental insurance plans, each with its own unique features and coverage options:

  • Delta Dental PPO: This plan offers the most flexibility, allowing you to visit any licensed dentist. You’ll save the most when you choose a dentist within the Delta Dental PPO network.
  • Delta Dental Premier: With this plan, you can visit any licensed dentist, but you’ll likely save more when you choose a dentist from the Delta Dental Premier network.
  • DeltaCare USA: This is a copay plan that requires you to select a primary care dentist from the DeltaCare USA network. You’ll receive a list of covered services with set copayments.

Orthodontic Coverage Under Delta Dental Plans

Most Delta Dental plans, including Delta Dental PPO and Delta Dental Premier, provide some level of coverage for orthodontic treatments. Typically, covered services include:

  • Pre-orthodontic treatment visits
  • Comprehensive orthodontic treatment
  • Post-treatment records
  • Retainers (one set per lifetime)

However, coverage for certain services may vary depending on your specific plan:

ServiceTypically Covered?
Two-phase orthodontic treatmentLess common
Appliances to correct harmful habits (e.g., thumb sucking)Less common
Jaw surgery to facilitate orthodontic treatmentLess common
Invisalign or other clear alignersVaries by plan

It’s crucial to review your plan’s details or consult with a Delta Dental representative to understand your specific coverage.

Coverage for Children vs. Adults

Delta Dental’s orthodontic coverage often differs between children and adults. While some plans may provide coverage for both, others may limit orthodontic benefits to children under a certain age (usually 18 or 19). However, with the growing popularity of adult orthodontics, more plans are beginning to offer coverage for adults as well.

According to the American Association of Orthodontists, the number of adult patients seeking orthodontic treatment has steadily increased over the years, with adults now making up roughly 25% of all orthodontic patients in the United States.

If you’re an adult considering braces, it’s essential to review your Delta Dental plan’s details carefully to determine if you have orthodontic coverage.

Lifetime Limits on Orthodontic Coverage

Many Delta Dental plans impose a lifetime limit on orthodontic coverage, which is the maximum amount the plan will pay toward orthodontic treatment for the duration of your coverage. This limit typically ranges from $1,000 to $2,000, depending on your plan.

For example, let’s say your plan covers 50% of orthodontic treatment costs up to a lifetime maximum of $1,500. If your total treatment cost is $6,000, Delta Dental would cover $1,500, and you would be responsible for the remaining $4,500.

It’s important to note that lifetime maximums generally only apply to orthodontic treatments and not to other dental services like cleanings, fillings, or root canals.

Delta Dental’s Payment Structure for Orthodontic Treatment

When it comes to paying for orthodontic treatment, Delta Dental typically follows a specific payment structure. In most cases, Delta Dental will make an initial payment at the beginning of treatment, followed by a second payment (if applicable) 12 months later as treatment progresses.

For instance, if your plan’s orthodontic lifetime maximum is $1,500, Delta Dental may pay $1,000 upfront and the remaining $500 after 12 months of treatment.

Choosing an Orthodontist

To maximize your Delta Dental orthodontic coverage, it’s crucial to choose an orthodontist who participates in your plan’s network. Delta Dental PPO and Delta Dental Premier plans allow you to visit any licensed orthodontist, but you’ll generally save the most when you choose an in-network provider.

With DeltaCare USA plans, you must select a primary care dentist from the DeltaCare USA network to receive benefits. This dentist will coordinate any necessary orthodontic treatment with a participating orthodontist.

You can easily find in-network orthodontists using Delta Dental’s online provider search tool or by contacting customer service for assistance.

Pre-Treatment Estimates

Before beginning orthodontic treatment, it’s wise to request a pre-treatment estimate from your orthodontist. This estimate will give you a clear idea of the total cost of treatment, including how much Delta Dental will cover and your out-of-pocket expenses.

To obtain a pre-treatment estimate, your orthodontist will submit a treatment plan to Delta Dental for review. Delta Dental will then provide a breakdown of the covered services, the amount they will pay, and your financial responsibility.

Types of Braces Covered

Delta Dental plans typically cover a wide range of orthodontic appliances, including:

  1. Traditional metal braces
  2. Ceramic braces
  3. Lingual braces
  4. Invisalign or other clear aligners (depending on your plan)

Your specific coverage for each type of appliance may vary, so it’s essential to consult with your orthodontist and review your plan details to determine the best option for your needs and budget.

Invisalign Coverage

Invisalign, a popular alternative to traditional braces, uses a series of clear, removable aligners to gradually straighten teeth. Many Delta Dental plans cover Invisalign treatment, but the extent of coverage can vary.

If your plan includes orthodontic benefits, it will likely cover a portion of the cost of Invisalign, subject to your lifetime orthodontic maximum. However, some plans may have specific exclusions or limitations for Invisalign treatment, so it’s crucial to review your plan’s details carefully.

It’s also important to note that Delta Dental does not cover at-home clear aligner treatments like SmileDirectClub or Byte. These DIY treatments are not considered a standard benefit under Delta Dental plans.

Cost of Braces with Delta Dental Coverage

The cost of braces can vary significantly depending on factors such as the type of braces, the severity of your case, and your location. On average, traditional metal braces can cost between $3,000 and $7,000, while Invisalign treatment can range from $3,000 to $8,000.

With Delta Dental coverage, you can expect to pay a portion of these costs out-of-pocket, depending on your plan’s orthodontic coverage percentage and lifetime maximum. For example, if your plan covers 50% of orthodontic treatment with a $1,500 lifetime maximum, and your total treatment cost is $6,000, you would be responsible for $4,500.

To get a more accurate estimate of your out-of-pocket costs, consult with your orthodontist and request a pre-treatment estimate.

Conclusion

Delta Dental offers a range of dental insurance plans with varying levels of coverage for orthodontic treatments like braces. Understanding your plan’s specific benefits, limitations, and network requirements is key to maximizing your coverage and minimizing your out-of-pocket expenses.

By working closely with your orthodontist, obtaining pre-treatment estimates, and staying within your plan’s network, you can achieve a healthier, more confident smile while making the most of your Delta Dental benefits in 2024.

Remember, investing in orthodontic treatment is an investment in your long-term oral health and well-being. With Delta Dental’s support, you can navigate the path to a straighter, brighter smile with greater ease and confidence.

Does Delta Dental Cover Braces?

Yes, Delta Dental does cover braces, but the extent of the coverage depends on the specific plan. Most Delta Dental plans include coverage for pre-orthodontic treatment visits, exams, start-up records, and X-rays. However, it’s less common for plans to cover two-phase orthodontic treatment or appliances to correct harmful habits like thumb-sucking.

What Types of Braces Does Delta Dental Cover?

Delta Dental covers a variety of braces, including metal braces, clear ceramic braces, and concealed braces that attach to the back of your teeth. The coverage for “invisible aligners” like Invisalign is also included as a standard benefit in most plans.

Does Delta Dental Cover Orthodontic Treatment for Adults?

Yes, adult orthodontic coverage is available for both Delta Dental PPO™ and DeltaCare® USA group plans. For individual plans, adult orthodontics is covered under the PPO Premium Plan and DeltaCare USA plans.

What is the Age Limit for Orthodontic Coverage with Delta Dental?

The age limit for orthodontic coverage varies depending on the specific Delta Dental plan. Some plans cover orthodontic services up to age 19, while others have no age limit as long as you and your eligible dependents remain enrolled. Most dental plans will cover adult “children” until age 26.

How Does Delta Dental Handle Payments for Orthodontic Treatments?

For treatments under $500, Delta Dental makes a lump-sum payment once banding has occurred. For treatments over $500, payments are made in two installments: once banding has occurred and 12 months later, depending on eligibility.