When it comes to dental care, braces are often a significant expense. Many individuals seek dental insurance to help manage the costs. Delta Dental is one of the most popular dental insurance providers in the United States, but many people wonder if their plans cover braces. In this article, we will explore how Delta Dental insurance works for braces and the factors that can affect coverage.
Understanding Delta Dental Insurance
Delta Dental offers a variety of dental insurance plans, each with different coverage levels. These plans can include preventive care, basic dental treatments, and even major dental procedures like braces. However, coverage for braces is not guaranteed for all plans. To understand whether braces are covered, it’s important to know what type of plan you have.
Types of Delta Dental Plans
Delta Dental offers two main types of plans:
Delta Dental PPO – This plan allows you to choose any dentist, but you will save more if you see a dentist within the Delta Dental network. It is often chosen by individuals who prefer flexibility in choosing their dental care providers.
Delta Dental Premier – This plan offers a wider network of dentists compared to the PPO plan but may have higher out-of-pocket costs. It is ideal for people who want a balance of cost and access to dentists in the network.
What Does Delta Dental Insurance Typically Cover?
Most Delta Dental insurance plans cover a range of dental services, including preventive care like cleanings and exams, basic services such as fillings, and sometimes more complex procedures. However, dental plans vary, and coverage for orthodontic treatments like braces can differ widely. Typically, orthodontic coverage is only provided under certain conditions.
Does Delta Dental Cover Braces?
The short answer is: it depends. Delta Dental does provide coverage for braces, but not all plans include orthodontics, and coverage is often subject to certain conditions.
Orthodontic Coverage for Children
Most Delta Dental plans include orthodontic coverage for children. This is because braces are commonly needed for younger individuals, especially those who have significant misalignments or bite issues. However, orthodontic coverage for children may have limitations:
Age Restrictions – Some plans cover braces only for children under a certain age, typically around 19 years old.
Waiting Periods – Many plans have a waiting period before orthodontic benefits become available. This can range from 6 months to a year or more.
Coverage Limits – Delta Dental plans often have a lifetime maximum benefit for orthodontic treatments, which is the total amount the plan will pay for braces over the course of the patient’s lifetime.
Orthodontic Coverage for Adults
Orthodontic coverage for adults is not as common in Delta Dental plans. While some Delta Dental PPO plans may cover braces for adults, this is typically less common and can come with specific restrictions:
Medical Necessity – For adult braces, the treatment may need to be deemed medically necessary. For example, if the misalignment is affecting the patient’s ability to chew or speak properly, braces may be covered.
Cosmetic Procedures – Braces for cosmetic reasons (e.g., for improving appearance rather than addressing functional issues) are typically not covered.
Limited Coverage – Even if orthodontic treatment for adults is covered, the plan may only cover a portion of the total cost.
What Factors Affect Coverage for Braces?
Several factors influence whether Delta Dental will cover braces for you or your child. These factors include:
1. Type of Plan
As mentioned earlier, not all Delta Dental plans offer orthodontic coverage. The more basic plans may not include this benefit. If you are considering braces, it is important to check the specifics of your plan to see if orthodontic treatment is covered.
2. Age of the Patient
For children, braces are typically covered more often than for adults. Delta Dental plans usually include orthodontic coverage for children, but there may be age limits or waiting periods to consider. In some cases, braces are not covered for adults unless there is a medical necessity.
3. Medical Necessity
Braces for medical reasons, such as correcting an overbite or underbite that impacts the ability to eat or speak, are more likely to be covered. However, if the braces are considered purely cosmetic, such as for aesthetic purposes, they may not be covered under your plan.
4. Pre-authorization
Many Delta Dental plans require pre-authorization before starting orthodontic treatment. This means that the orthodontist must submit a treatment plan to Delta Dental for approval before braces are placed. If the treatment is not deemed medically necessary or does not meet the plan’s guidelines, coverage may be denied.
5. Waiting Periods and Limitations
Some plans have waiting periods before orthodontic benefits kick in, while others may have annual or life time maximums for orthodontic coverage. It is important to know how long you need to wait and how much your plan will pay toward the cost of braces.
6. Network Restrictions
If your Delta Dental plan is a PPO or Premier plan, the amount of coverage you receive may depend on whether you use an in-network orthodontist. Delta Dental usually has a network of approved orthodontists who provide services at a lower cost than out-of-network providers.
How Much Does Delta Dental Cover for Braces?
The amount of coverage Delta Dental provides for braces depends on the specific plan and the circumstances surrounding the treatment. In general, most plans offer coverage for a percentage of the total cost of braces. The exact percentage can vary, but here’s what you can expect:
Coverage for Children
For children, Delta Dental often covers a significant portion of the cost. This can range from 50% to 80% of the total cost of braces, depending on your plan. However, you may still be responsible for the remaining costs, including co-pays, deductibles, and any costs above your plan’s lifetime maximum for orthodontic treatment.
Coverage for Adults
For adults, the coverage is less common and can be more limited. Some plans may cover up to 50% of the cost of braces for adults, but only if the treatment is deemed medically necessary. If the braces are considered cosmetic, they are typically not covered at all.
What Are the Costs of Braces?
The cost of braces can vary widely based on several factors, including the type of braces (metal, ceramic, Invisalign), the complexity of the treatment, and the location of the orthodontist. On average, braces can cost between $3,000 and $7,000 for a full course of treatment.
Even with insurance, the cost can still be substantial, and patients should expect to pay out-of-pocket for a portion of the expenses. Delta Dental’s coverage will help reduce the cost, but it’s important to understand the limits of your plan before moving forward with treatment.
Alternatives to Braces Coverage
If Delta Dental does not provide sufficient coverage for braces or if you do not have orthodontic benefits, there are other options to help with the costs:
1. Flexible Spending Accounts (FSAs)
Many employers offer FSAs, which allow employees to set aside pre-tax money for medical expenses. This can be a great option to help pay for braces, as the funds can be used for orthodontic treatment.
2. Health Savings Accounts (HSAs)
If you have a high-deductible health plan, you may be eligible for an HSA, which also allows you to save money for medical expenses on a tax-free basis.
3. Financing Options
Many orthodontists offer financing plans or payment plans, allowing patients to pay for braces in installments rather than all at once. Some dental offices may also work with third-party financing companies to provide affordable monthly payments.
How to Check if Your Delta Dental Plan Covers Braces
To determine whether your Delta Dental plan covers braces, follow these steps:
Review Your Plan Documents – Your policy documents will outline the coverage details for orthodontics.
Contact Delta Dental – Call customer service or visit the Delta Dental website to verify if orthodontic coverage is included in your plan.
Consult with an Orthodontist – Schedule a consultation with an orthodontist to discuss the cost of treatment and whether Delta Dental can help cover it.
Conclusion
Delta Dental may cover braces, but the extent of coverage depends on the specific plan, the age of the patient, and whether the treatment is deemed medically necessary. For children, braces are more likely to be covered, while adult orthodontic coverage is typically more limited. Before pursuing orthodontic treatment, it’s essential to understand your plan’s specifics, including any waiting periods, lifetime maximums, and in-network restrictions. If braces are not fully covered, consider other financial options like FSAs, HSAs, or financing plans. Always reach out to Delta Dental and your orthodontist to get a clear understanding of your coverage and costs.
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