January 21, 2025

Comprehensive Guide: Does Delta Dental Cover Orthodontic Treatments?

Navigating dental insurance can be overwhelming, especially when trying to understand Delta Dental’s specific coverage for orthodontic treatments like Invisalign, braces, or implants. This guide answers your key questions and provides insights into maximizing your Delta Dental benefits.

Does Delta Dental Cover Invisalign?

Yes, Delta Dental often covers Invisalign under orthodontic benefits, but coverage details depend on your specific plan. Some plans classify Invisalign as an orthodontic treatment, while others may exclude it or cover only traditional braces.

Why Being In-Network Saves You Money

At Elate Orthodontics, we are in-network with Delta Dental, which means we have agreed to pre-negotiated rates for services. This saves you significant money compared to seeing an out-of-network provider.

In-Network Savings: When you visit an in-network provider, you pay only the portion not covered by Delta Dental, which is typically lower.
Out-of-Network Costs: While out-of-network providers may accept Delta Dental, you may be charged the difference between the provider’s fees and Delta Dental’s allowable charges—resulting in higher out-of-pocket costs.

Example: How Delta Dental Benefits Work for Orthodontics

Imagine you have Delta Dental and are starting Invisalign treatment with a cost of $6,000. Here’s how being in-network with Elate Orthodontics saves you money:

Scenario 1: In-Network Provider (Elate Orthodontics)

Delta Dental’s Negotiated Fee: $5,000 (reduced cost due to in-network rates).
Coverage Percentage: 50% of $5,000 = $2,500 paid by Delta Dental.
Out-of-Pocket Cost: $2,500 (your portion).

Scenario 2: Out-of-Network Provider

Provider Fee: $6,000.
Delta Dental’s Allowed Amount: $5,000 (they only reimburse up to this amount).
Coverage Percentage: 50% of $5,000 = $2,500 paid by Delta Dental.
Out-of-Pocket Cost: $3,500 ($1,000 difference plus your portion).

In this example, staying in-network saves you $1,000.

How Delta Dental’s Annual Maximum Works

Delta Dental plans often include an annual maximum, which is the total amount they will pay for covered treatments within a calendar year. For example:

If your plan’s annual maximum is $1,500, and you’ve used $1,000 for fillings or cleanings, you’ll have $500 remaining for other treatments that year.
Orthodontic treatments often fall under a lifetime orthodontic maximum, which is separate from the annual maximum.

How Delta Dental’s Out-of-Pocket Maximum Works

The out-of-pocket maximum limits what you pay for covered treatments within a year. Once this cap is reached, Delta Dental covers 100% of remaining eligible expenses. However, orthodontic treatments typically do not count toward this maximum, so separate costs may apply.

Maintaining Coverage During Orthodontic Treatment

It’s crucial to maintain your Delta Dental insurance for the entire duration of your orthodontic treatment. If your coverage lapses:

Delta Dental will stop paying their portion.
You will be responsible for the remaining balance, which can significantly increase your out-of-pocket costs.

For example, if your Invisalign treatment is spread over 24 months, and you cancel your insurance after 12 months, Delta Dental will not cover the remaining 12 months of treatment.

Does Delta Dental Cover Braces for Children?

Yes, most Delta Dental plans include coverage for children’s braces. Typically:

Coverage Percentage: Plans cover 50-60% of the cost.
Lifetime Maximum: Often set at $1,500 to $2,000 per person.
Age Limitations: Some plans have an age cap for coverage, such as under 18.

Does Delta Dental Cover Orthodontics for Adults?

Delta Dental plans often provide orthodontic coverage for adults, but benefits are typically less generous than for children. Invisalign or braces for adults may be covered at a lower percentage or have stricter limits.

Is Delta Dental Good Insurance?

Delta Dental is widely regarded as a leading dental insurance provider because:

Broad Coverage: They offer plans for preventive, restorative, and orthodontic services.
Large Network: Their vast network includes providers like Elate Orthodontics, ensuring cost savings.
Affordable Plans: Options are available to fit a variety of budgets.

Who Takes Delta Dental Near Me?

At Elate Orthodontics, we proudly accept Delta Dental and are in-network, ensuring you receive the maximum cost-saving benefits.

Locations: We have offices in The Colony, Frisco, and Prosper, making access convenient.

Does Delta Dental Cover Invisalign for Adults?

Yes, but coverage varies. Invisalign is often categorized as an orthodontic treatment, meaning coverage may depend on lifetime maximums and plan limitations.

Let Elate Orthodontics Help You Maximize Your Benefits

At Elate Orthodontics, we make it easy to understand and maximize your Delta Dental insurance. Our friendly team will verify your benefits, explain your coverage, and provide affordable treatment options to fit your needs.

Helpful Resources

Start your journey to a confident smile today with Elate Orthodontics!

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