Does Delta Dental Cover Invisalign?


Does Delta Dental Cover Invisalign

Invisalign has surged in popularity as a discreet alternative to traditional metal braces for adults looking to straighten their teeth. These clear plastic aligners are virtually invisible, removable, and often considered more comfortable than braces. But with the average cost of Invisalign treatment in the USA ranging from $3,000 to $8,000, many patients wonder if their dental insurance, such as Delta Dental, will help cover the expense.

Delta Dental is one of the largest dental insurance providers in the United States, covering over 80 million Americans through various employer groups and plans. However, the extent of Invisalign coverage can vary significantly depending on the specific Delta Dental plan.

Key Factors Influencing Delta Dental’s Invisalign Coverage

Several crucial factors determine if and how much a Delta Dental insurance plan will cover Invisalign treatment:

1. Type of Delta Dental Plan

Delta Dental offers different plan types, each with varying levels of coverage:

  • DeltaCare USA: These dental HMO plans require selecting a primary care dentist from the DeltaCare USA network to coordinate all treatment. Adult orthodontic coverage, including Invisalign, is typically not included.
  • Delta Dental PPO: PPO plans provide the flexibility to visit any licensed dentist but offer maximum coverage when using an in-network Delta Dental PPO dentist. Partial coverage or an allowance for Invisalign treatment is often available.
  • Delta Dental Premier: Similar to PPO plans, Premier plans allow visiting any licensed dentist but with lower out-of-network coverage. A portion of Invisalign costs may be covered.
  • Other Plan Types: Less common options like DeltaCare USA Direct, Delta Dental Medicaid plans, or Health Insurance Marketplace plans may have limited or no orthodontic benefits.

2. Age Limits on Orthodontic Coverage

Many dental insurance plans restrict orthodontic coverage to those under 19 years old. Even if a Delta Dental plan includes Invisalign benefits, it may only apply to teenage dependents rather than adults. Reviewing the specific age limitations for orthodontic coverage is essential.

3. Annual Maximum Benefits

Delta Dental plans often have an annual maximum benefit amount, typically $1,000 to $2,000 per person, which caps the total yearly reimbursement. Any Invisalign costs exceeding the covered amount under the annual maximum are the patient’s responsibility.

Additionally, many plans have a separate lifetime maximum specifically for orthodontics like Invisalign, often around $1,500. Reaching these maximums early in treatment can result in paying the full price for the remaining clear aligner therapy.

Percentage of Invisalign Costs Covered by Delta Dental

The percentage of Invisalign treatment covered by Delta Dental varies greatly depending on the specific insurance plan.

Some Delta Dental PPO or Premier plans may cover approximately 50% of the total Invisalign cost. However, this percentage can range from as low as 20% to as high as 60% for other plans, factoring in deductibles and maximums.

Here are some examples of Delta Dental plans and their typical Invisalign coverage percentages:

Delta Dental PlanInvisalign Coverage
Delta Dental PPO plus Premier50% for Premier dentist, 60% for PPO dentist
Delta Dental PPOTM50% after $50 lifetime deductible per person
DeltaCare® USA Family BasicNo adult coverage due to age limits
Delta Dental of Massachusetts20% after $100 lifetime deductible per person

Keep in mind that the patient’s out-of-pocket expenses for Invisalign are based on the total treatment cost quoted by their orthodontist, which can vary significantly by region, individual treatment plan, required retainers, and other factors.

Delta Dental Coverage for Invisalign Alternatives

In addition to Invisalign, Delta Dental may cover other clear aligner options, such as:

  • ClearCorrect: Offering similar clear aligner therapy to Invisalign, ClearCorrect is often covered at the same percentage by Delta Dental plans that include Invisalign benefits.
  • SureSmile: Utilizing 3D imaging and robotics to create custom aligners, SureSmile may receive partial coverage under Delta Dental plans with orthodontic benefits.

However, Delta Dental does not cover direct-to-consumer clear aligner companies like SmileDirectClub, Byte, or Candid. These do-it-yourself aligner treatments are considered elective cosmetic procedures rather than medically necessary orthodontia, making them ineligible for insurance coverage under Delta Dental plans.

Choosing a Dentist or Orthodontist for Invisalign Coverage

Generally, Delta Dental’s Invisalign coverage is higher when visiting an in-network dentist or orthodontist.

For Delta Dental PPO plans, coverage is maximized by using an in-network PPO dentist, with lower reimbursement for Premier network or out-of-network providers. Some plans may offer very limited or no coverage for out-of-network orthodontic treatment.

When considering Invisalign, it’s best to choose an orthodontist or dentist participating in the Delta Dental PPO network whenever possible.

DeltaCare USA plans require visiting contracted orthodontists within the HMO network, as care must be coordinated through a selected primary care dentist. Treatment must be pre-approved by the DeltaCare USA general dentist and is not covered out-of-network.

Confirming Delta Dental’s Invisalign Coverage

With numerous variables affecting Invisalign coverage, the most reliable way to confirm if a specific Delta Dental plan will reimburse treatment costs is to:

  1. Review Plan Documents: Check the plan’s coverage details for information on orthodontic or Invisalign benefits, age limits, deductibles, and maximums.
  2. Contact Delta Dental: Speak with a Delta Dental representative by phone or online chat for clarification on expected Invisalign coverage.
  3. Consult the Orthodontist/Dentist: Schedule an appointment with an in-network orthodontist or dentist and have them verify coverage specifics through Delta Dental before starting treatment.

Obtaining this information on Delta Dental’s Invisalign benefits prior to beginning clear aligner therapy allows for budgeting out-of-pocket costs and assessing the affordability of treatment.

Appealing Delta Dental’s Denial of Invisalign Coverage

If Delta Dental denies coverage for Invisalign treatment, patients have options to appeal for reconsideration:

  1. File a First-Level Appeal: Explain why Invisalign is medically necessary and should be covered under the policy’s orthodontic benefits, providing supporting documentation from the treating orthodontist.
  2. File a Second-Level Appeal: If the first appeal is unsuccessful, request an additional dental expert review the necessity of Invisalign treatment.
  3. Contact the State’s Department of Insurance: As a last resort, request an investigation into wrongful denial of coverage.

Having an experienced orthodontist advocate on your behalf is crucial for successfully appealing denied Invisalign claims with Delta Dental. Thorough record-keeping and persistence in moving through every level of appeal is often necessary to reverse an adverse decision.

Final Thoughts on Delta Dental & Invisalign

While several Delta Dental plans offer partial reimbursement for Invisalign treatment, coverage varies considerably. Carefully evaluating the specifics of your insurance policy, coordinating benefits in advance with your dental providers, and budgeting for out-of-pocket costs is crucial.

With persistence through the appeals process, some patients may eventually secure more coverage from their insurer. However, adequate planning and preparation are essential when navigating Delta Dental’s benefits for Invisalign treatment.

By understanding the factors influencing coverage, working with in-network providers, and being proactive in confirming benefits, patients can make informed decisions about pursuing Invisalign therapy with the support of their Delta Dental insurance plan in 2024 and beyond.

Does Delta Dental Cover Invisalign?

Yes, Delta Dental plans often include coverage for Invisalign as a standard benefit if adult orthodontic coverage is part of the plan. Coverage levels and eligibility can vary, so it’s important to check the specifics of your plan.

What Percentage of Invisalign Cost Does Delta Dental Cover?

Delta Dental typically covers around 50% of the cost for Invisalign, subject to plan specifics and maximum benefit limits. Some plans may have a maximum annual payout, which can affect the total coverage amount.

Are There Age Restrictions for Invisalign Coverage with Delta Dental?

Some Delta Dental plans may limit orthodontic benefits, including Invisalign, to members who are 19 years of age or younger. However, this varies by plan, and some do not have an age limit.

Can Delta Dental Coverage for Invisalign Vary by Plan or State?

Yes, coverage for Invisalign with Delta Dental can vary depending on the plan and state. Different plans have different levels of coverage, and some states may have specific regulations affecting coverage.

How Do I Know if My Delta Dental Plan Covers Invisalign?

To determine if your Delta Dental plan covers Invisalign, review your plan’s Summary of Dental Benefits or contact Delta Dental customer service. You can also consult with your orthodontist, who can provide a pre-determination of benefits.