Navigating the complexities of dental insurance can often be a perplexing task, especially when it comes to understanding coverage for orthodontic treatments like braces. Delta Dental, a prominent figure in the dental insurance landscape, offers various plans that may or may not include orthodontic coverage. This article delves into the specifics of Delta Dental’s policies regarding braces, aiming to clarify the nuances of different insurance plans and what they mean for you. Whether you’re considering braces for yourself or a family member, it’s essential to comprehend the insurance implications to make informed decisions.
Understanding Delta Dental’s Coverage for Braces
Delta Dental offers a variety of dental insurance plans, each with unique characteristics and coverage options. When it comes to orthodontic treatments, such as braces, the coverage details can vary significantly across different plans. Here, we’ll delve into the specifics of Delta Dental’s coverage for braces, focusing on plan variations, coverage for children versus adults, and lifetime limits on orthodontic coverage.
Plan Variations and Orthodontic Plans
Delta Dental provides several types of dental insurance plans, including Preferred Provider Organizations (PPO), Dental Health Maintenance Organization (HMO), Dental Discount or Dental Savings Plans, and Managed Fee-for-Service Plans. Each of these plans has unique characteristics and coverage options.
Most Delta Dental plans, such as Delta Dental PPO and Delta Dental Premier, include coverage for pre-orthodontic treatment visits, examination and start-up records, and comprehensive orthodontic treatment. However, it’s less common for plans to cover two-phase orthodontic treatment, appliances to correct harmful habits like thumb-sucking, and jaw surgery to facilitate orthodontic treatment.
Some plans may cover alternative appliances like Invisalign. If an appliance is not covered, Delta Dental usually covers some of the orthodontic treatment costs, which can reduce your overall expenses.
Coverage for Children vs Adults
Orthodontic coverage often varies between children and adults. More adults are having their teeth straightened than before, and the cost of braces for adults depends on whether or not your plan offers orthodontic coverage. Costs can vary depending on your coverage, the services you need, and whether or not you see an in-network orthodontist.
Lifetime Limits on Orthodontic Coverage
A common feature across many Delta Dental plans is the presence of a lifetime limit on orthodontic coverage. Lifetime maximums rarely limit services like cleanings, regular checkups, fillings, crowns, root canals, or periodontal treatments. Usually, they only apply to specific services such as orthodontic treatments.
For example, many plans will cover a fixed percent of orthodontic treatment in a plan year, up to an orthodontic lifetime maximum. If the cost of orthodontic treatment (braces) is $6,000 and the dental plan covers 50% of orthodontics up to the lifetime maximum of $1,500, your dental plan would cover $1,500 and you would be responsible for the remaining cost.
In most cases, Delta Dental will make an initial payment of $1,000, with a second payment (if the plan’s orthodontic lifetime maximum is higher) made 12 months later as treatment progresses.
Types of Delta Dental Plans
Delta Dental offers a variety of dental plans to cater to different needs and budgets. Two of the most popular plans are DeltaCare USA and Delta Dental PPO. Each plan provides varying degrees of coverage, including for orthodontic treatments like braces.
DeltaCare USA
DeltaCare USA is a copay plan that offers comprehensive dental coverage with no waiting periods, no hidden fees, no annual maximums, and no deductibles. This plan is convenient and predictable, making it a great solution for those who prefer to plan for costs ahead of time.
Under this plan, you’ll select a primary care dentist from the DeltaCare USA network who you must visit to receive benefits. You’ll receive a list of covered services with set copayments, so you know all your costs for covered services upfront.
Orthodontic coverage under DeltaCare USA varies depending on your plan, but most plans include pre-orthodontic treatment exams, treatment planning sessions, pre- and post-treatment records, limited, interceptive and comprehensive orthodontic treatment, and retention (including retainers) .
Delta Dental PPO
Delta Dental PPO is a plan that covers a percentage of your costs for covered dental services. After you meet your annual deductible, you pay your share of the bill, and your plan pays the rest. This plan is flexible, allowing you to visit any licensed dentist, though you’ll likely save the most with a Delta Dental PPO dentist.
Orthodontic coverage under Delta Dental PPO varies depending on your plan, but most plans include pre-orthodontic treatment visits, exams and start-up records, and X-rays. One set of post-treatment retainers is typically covered in a lifetime. If your plan covers two-phase orthodontic treatment, retainers are usually covered after each phase.
Delta Dental HDS Deluxe
The Delta Dental HDS Deluxe plan offers 50% coverage on braces for children and adults up to age 25, with a lifetime maximum of $1,000.
Delta Dental PPO Premium Plan
The Delta Dental PPO Premium Plan offers up to 50% coverage with a $1,500 maximum per individual. This plan includes a 6-month waiting period.
Choosing the Right Plan
Choosing the right dental plan depends on your individual needs and circumstances. Consider factors such as your budget, your dental health needs, and your preference for seeing specific dentists. Delta Dental offers a range of plans to suit different needs, so you can find a plan that offers the right balance of cost and coverage for you.
Remember, it’s important to read the fine print of any dental plan you’re considering. Make sure you understand what’s covered, what’s not, and how much you’ll pay out-of-pocket for different types of services. If you have any questions, don’t hesitate to reach out to Delta Dental or a trusted insurance advisor for guidance.
Does Delta Dental Cover Invisalign and Other Clear Aligners?
Navigating the world of dental insurance can be a daunting task, especially when it comes to understanding what treatments are covered. One common question is whether Delta Dental, a leading provider of dental insurance, covers Invisalign and other clear aligners.
Invisalign Coverage
If your plan includes adult orthodontic coverage, Delta Dental does indeed cover the well-known brand of clear aligners called Invisalign. These “invisible aligners” are considered a standard benefit under such plans. However, the specifics of your coverage will depend on your group’s specific plan contract.
For instance, if you’re interested in Invisalign, it’s recommended that you or your orthodontist submit a pre-treatment estimate before treatment begins. This will give you a clear idea of how much Delta Dental will cover and how much you’ll need to pay out-of-pocket.
Remember, Delta Dental PPO plan members can see any licensed orthodontist, and they’ll usually save the most when they choose a Delta Dental orthodontist.
At-Home Aligners
While a dental professional typically administers Invisalign, there are also at-home clear aligners available from businesses like SmileDirectClub or Byte. However, Delta Dental does not cover these DIY treatments. The company believes that teeth straightening is a complex process that should be overseen by a dental professional to avoid potential long-term problems.
Cost of Braces and Aligners Without Insurance
If you’re considering orthodontic treatment without insurance, it’s important to understand the potential costs.
- Traditional Braces: These can range from $2,500 to $7,500, depending on factors like the severity of your dental issues, your location, and the type of braces you choose.
- Invisalign: The average cost of Invisalign treatment ranges between $3,000 and $8,000. The length of your treatment and the level of expertise of your dentist are two factors that can affect this cost.
- At-Home Clear Aligners: These alternatives are generally more affordable, with costs typically ranging between $1,200 and $2,500.
| Treatment | Covered by Delta Dental | Average Cost Without Insurance |
|---|---|---|
| Traditional Braces | Depends on plan | $2,500 – $7,500 |
| Invisalign | Yes, if plan includes adult orthodontic coverage | $3,000 – $8,000 |
| At-Home Clear Aligners | No | $1,200 – $2,500 |
Remember, the best way to achieve a perfect smile is by working with a qualified healthcare professional. This is especially true if you have significant alignment problems or a severe underbite or overbite.
Determining if You Need Braces
A healthy, confident smile can make a world of difference. However, not everyone is born with a perfect set of teeth. This is where braces come into play. They are not just for children but suitable for individuals of all ages.
Indicators for Braces
Overcrowded or misaligned teeth: This is one of the most common signs that you might need braces. Overcrowding can make brushing and flossing difficult, increasing the risk of tooth decay and gum disease.
Significant space between teeth: Large gaps in your smile can result in tooth decay, jaw misalignment, and eating complications. Food may easily get stuck in the gaps, causing sensitive gums and ongoing pain. Braces can help in reducing these gaps and prevent future problems.
Bite issues like overbite or underbite: An overbite occurs when the upper front teeth overlap the lower front teeth when biting down. This can affect the symmetry of your smile and lead to various issues like difficulty with proper biting and chewing, leading to problems with digestion. It may also contribute to speech difficulties and even jaw pain. An underbite happens when all of the upper front teeth are behind the lower front teeth. This usually occurs when an individual has an inconsistent jaw size. Individuals with an underbite may experience difficulty chewing and biting.
Jaw misalignment affecting bite: If you experience difficulty biting or chewing your food, uneven wear on teeth, or persistent jaw pain, these could suggest alignment issues. Speech difficulties, such as lisping or slurring, can even be connected to dental misalignment.
Braces for All Ages
Contrary to common belief, braces are suitable for individuals of all ages, not just children. Over 20% of the patients in some practices are over the age of 21. The American Association of Orthodontists recommends that children first visit an orthodontist around the age of seven. At this time, the orthodontist can identify any growth issues and make plans to address them or monitor progress over the next months or years.
For adults, it’s never too late to start orthodontic treatment. The primary difference between treating adults and children is that adults’ jawbones have stopped growing, while children’s are still developing.
Whether you’re considering treatment for yourself or for a child, any time is a good time to visit the orthodontist. An initial exam can provide all the information you need to start your journey towards a healthier smile.
Types of Braces
Orthodontic treatment has evolved significantly over the years, offering a variety of appliances to address dental and jaw issues. Here, we delve into the details of the most common types of braces, their unique features, and who they’re best suited for.
Traditional Metal Braces
Traditional metal braces are the most common type of braces worldwide and have been around for over a century. They consist of stainless steel bands, brackets, and wires that gently shift your teeth over time. A dentist or orthodontist bonds a bracket on each tooth, then places a thin, flexible archwire over the brackets. Tiny elastic bands, known as ligatures, keep the wire firmly in place.
These braces are visible when you smile, but you can choose clear or tooth-colored ligatures to make them less noticeable. They are efficient, versatile, and require appointments every 4-8 weeks for adjustments. However, they can be difficult to clean, and good oral hygiene is crucial throughout treatment.
Ceramic Braces
Ceramic braces, sometimes called clear braces, work similarly to metal braces. The key difference is that the brackets, wires, and ligatures are tooth-colored, so they blend in with your smile. They are less noticeable and present an affordable alternative to metal braces. However, they are slightly larger than metal braces and can stain depending on diet and brushing habits.
Self-Ligating Braces
Self-ligating braces work similarly to metal and ceramic braces. The main difference is that, instead of ligatures, self-ligating braces use a built-in system to hold the archwire in place. They are easier to clean and offer a great option for orthodontic treatment with fewer appointments.
Lingual Braces
Lingual braces are similar to traditional braces but are attached to the back surfaces of the teeth instead of the front. They are the most specialized and least common orthodontic system on the market, requiring a different set of orthodontic skills. They are especially well-suited for adults who do not want noticeable braces but have complex orthodontic needs. However, some patients experience slight changes to their speech and irritation to their tongue.
Invisible Retainers (Clear Aligners)
Sometimes called “invisible braces,” clear aligners are a braces alternative. Instead of brackets and wires, clear aligners use a series of custom-made trays to straighten your teeth over time. Popular brands include Invisalign® and ClearCorrect® . They are clear, removable, allow for easier brushing and flossing, and require fewer appointments in some cases.
Accessing Delta Dental Orthodontic Coverage
Navigating the world of dental insurance can be complex, but understanding your options can help you make the most of your coverage. Delta Dental, one of the leading dental insurance providers, offers a variety of plans that include orthodontic coverage. Here’s how you can access these benefits.
Employer-Based Plans
Many individuals access dental insurance through their workplace, benefiting from pre-tax insurance payments and often lower rates. Employers typically offer one of two types of dental plans: fully-insured or self-funded. In a fully-insured plan, the insurance company is paid a monthly premium and takes on the risk of paying for the rest of the claims up to an annual cap. In a self-funded plan, the employer assumes the responsibility of paying for claims, often spreading the risk over a larger number of people.
Delta Dental offers a range of services and providers under its employer-based plans. You receive in-network benefits when seeing a Delta Dental PPO Network dentist. For out-of-network benefits, you can save money by seeing providers in the Delta Dental Premier Network. In both cases, providers accept the Delta Dental contracted fee, so there will be no additional balance billing charge.
Individual Plans
Individual plans can be purchased at any time and might offer more substantial orthodontic coverage compared to employer-based plans. Delta Dental offers three types of individual plans: Delta Dental PPO plan, Delta Dental EPO plan, and Delta Dental PPO Bright Smiles plan. Each plan comes with its own set of benefits and restrictions, so it’s important to review the details of each plan to determine which one best fits your needs.
In-Network Requirement
To maximize coverage, treatments must be conducted by a dentist or orthodontist within Delta’s network. You can visit any licensed orthodontist under your plan, but you’ll usually save the most if you choose a Delta Dental orthodontist. You can search for a dentist at deltadentalins.com and enter “orthodontist” in the keyword field. You can also ask your general dentist to recommend an in-network orthodontist or call Customer Service for help.
Understanding Your Coverage
Orthodontic coverage varies depending on your plan, but most Delta Dental plans include pre-orthodontic treatment visits, exams and start-up records, and X-rays. It is less common for plans to cover two-phase orthodontic treatment, appliances to correct harmful habits like thumb-sucking, and jaw surgery to facilitate orthodontic treatment. Typically, one set of post-treatment retainers (for orthodontic purposes) is covered in a lifetime.
Managing Costs
The cost of orthodontic treatment depends on the services you need. Delta Dental can help estimate costs before treatment begins. Ask your dentist to submit a pre-treatment estimate to Delta Dental, and they’ll send you and your dentist an overview of the total treatment cost, including how much your plan pays and your share of the cost.
Conclusion
Understanding the intricacies of Delta Dental’s coverage for braces is crucial for making informed decisions about orthodontic care. By comprehensively examining the types of plans available, their specific coverages, and the costs involved, individuals can navigate their dental insurance with confidence. It’s advisable to consult with orthodontic professionals and thoroughly review insurance plans for a clear understanding of the coverage details.
