Braces are a common orthodontic treatment for people with misaligned teeth. Many individuals and families want to know if Delta Dental Insurance covers the cost of braces. This article explains how Delta Dental’s coverage works, what to expect when getting braces, and how to make the most of your insurance.
Understanding Dental Insurance and Braces
Dental insurance helps pay for many oral health services, including check-ups, cleanings, and fillings. But braces are a different matter. Braces are a form of orthodontic treatment, and many people wonder if dental insurance covers them.
Delta Dental is one of the largest dental insurance providers in the United States. They offer a variety of plans, and each plan has different coverage details. Some plans might cover braces for children or adults, while others may not. Knowing what is covered under your Delta Dental plan is important before moving forward with treatment.
What Are Braces?
Braces are devices used to straighten teeth. They work by applying pressure to teeth over time, gradually shifting them into better alignment. Braces can improve the appearance of your smile and make it easier to clean your teeth, leading to better oral health.
Orthodontic treatment, including braces, is usually recommended for children, teens, or adults who have issues with their teeth or bite. Common problems that braces help with include:
Crooked or crowded teeth
Gaps between teeth
Overbites or underbites
Misaligned jaws
Why Is Braces Coverage Important?
Braces can be expensive, with total costs ranging from $3,000 to $10,000 depending on the type of braces and the length of treatment. Insurance coverage can help reduce the financial burden on families and individuals.
It’s essential to understand the specifics of your Delta Dental plan. Braces are often considered a specialty treatment, which means they might not be covered in the same way as routine dental care. Some Delta Dental plans provide coverage for braces, while others may offer limited coverage or exclude them altogether.
Types of Delta Dental Plans
Delta Dental offers different types of insurance plans, including PPO, HMO, and DeltaCare USA. Each plan has different coverage options. Some plans cover orthodontic treatments like braces, but others may not. It’s important to know which plan you have and what it covers.
PPO Plans
Delta Dental PPO (Preferred Provider Organization) plans typically offer more flexibility when choosing providers. If your plan covers braces, it will usually cover part of the cost, but the amount varies depending on your plan details. PPO plans usually provide a percentage of the total cost for orthodontic treatment, such as 50% to 80%.
HMO Plans
Delta Dental HMO (Health Maintenance Organization) plans have more limitations when it comes to choosing dental providers. These plans often require you to use in-network providers for orthodontic services, and they may have lower coverage amounts for braces. The coverage might also be limited to certain age groups, such as children or teenagers.
DeltaCare USA
DeltaCare USA is a type of managed care plan that requires you to choose a primary care dentist. With this plan, orthodontic coverage is typically available, but it may be limited in terms of the services covered and the amount paid. This plan is more restrictive in terms of providers, but it could still be useful if it covers braces.
Does Delta Dental Cover Braces?
The answer depends on your specific Delta Dental plan. In general, Delta Dental offers orthodontic coverage for both children and adults, but the level of coverage varies. Some plans may offer full coverage for braces, while others may only offer partial coverage. Additionally, some plans may exclude coverage for adults, offering it only for children under a certain age.
Coverage for Children
Delta Dental plans that include orthodontic coverage for children often cover a portion of the cost of braces. The coverage typically applies to children under the age of 19, but the exact age limit varies by plan. Most plans cover a percentage of the total cost, with the remainder being the responsibility of the patient or their family.
Coverage for Adults
While braces are most commonly used for children and teenagers, many adults also seek orthodontic treatment. Some Delta Dental plans offer orthodontic coverage for adults, but it’s less common than coverage for children. If you have a Delta Dental plan that covers braces for adults, you may still need to meet certain conditions, such as a waiting period or coverage limits.
What Is Covered?
Delta Dental’s orthodontic coverage generally applies to traditional metal braces, ceramic braces, and clear aligners (like Invisalign). However, the coverage amount and the types of braces covered will depend on your plan. Some plans may only cover a portion of the treatment, while others may cover a larger percentage.
The following expenses might be covered under orthodontic treatment:
Diagnostic X-rays
Braces installation
Regular adjustments to the braces
Retainers after treatment
What Is Not Covered?
Delta Dental may not cover certain costs related to orthodontic treatment. Some common exclusions include:
Cosmetic procedures not related to correcting dental issues
Braces for purely cosmetic reasons
Charges for services not deemed medically necessary
Certain types of orthodontic appliances not covered by your plan
It’s important to review your plan’s details to understand what is and isn’t covered.
How to Determine If Braces Are Covered by Your Delta Dental Plan
To find out if braces are covered by your Delta Dental insurance, you can follow these steps:
Check Your Plan: Review your plan’s details to see if orthodontic coverage is included. You can access your plan information online or through your insurance provider.
Contact Customer Service: If you’re unsure whether your plan covers braces, contact Delta Dental’s customer service for clarification. They can explain the specifics of your coverage.
Speak with Your Dentist: Your dentist or orthodontist can also help determine if your treatment will be covered by your Delta Dental plan. They can provide the necessary documentation to submit a claim if your plan covers braces.
Get a Pre-Authorization: Some plans require pre-authorization for orthodontic treatments. This means you’ll need to get approval from Delta Dental before starting your treatment.
How Much Do Braces Cost Without Insurance?
If your Delta Dental plan doesn’t cover braces, or if you have limited coverage, you may need to pay for braces out of pocket. The cost of braces can vary widely depending on the type of braces, the duration of treatment, and the complexity of your case.
Here are some average costs for different types of braces:
Traditional metal braces: $3,000 to $7,000
Ceramic braces: $4,000 to $8,000
Clear aligners (Invisalign): $3,500 to $8,000
These costs usually include the initial consultation, the installation of braces, regular check-ups and adjustments, and retainers once treatment is completed.
Ways to Save on Braces Costs
If your Delta Dental plan doesn’t cover braces, or if you’re looking to reduce costs, there are a few ways to save:
Flexible Spending Accounts (FSAs) and Health Savings Accounts (HSAs): These accounts allow you to save money tax-free for medical expenses, including orthodontic treatment.
Payment Plans: Many orthodontists offer payment plans, so you can spread the cost of treatment over several months or years.
Discounted Services: Some orthodontists offer discounts if you pay upfront or if you are referred by a dental office that partners with Delta Dental.
Dental Schools: Dental schools often offer orthodontic treatment at a lower cost. Treatment is done by dental students under the supervision of experienced professionals.
Conclusion
Whether or not braces are covered by Delta Dental insurance depends on the specific plan you have. Most plans offer orthodontic coverage for children, but coverage for adults is less common. The best way to find out if braces are covered is to check your plan details or speak directly with Delta Dental. If braces are not covered, there are still ways to save, such as using FSAs or payment plans.
Understanding your Delta Dental coverage and the costs involved can help you make an informed decision about your orthodontic treatment. By planning ahead and taking advantage of insurance benefits, you can achieve a healthier, straighter smile.
Related topics:
