Delta Dental Clear Aligner Coverage

Key Takeaways

• If you have Delta Dental, you may have orthodontic coverage depending on your plan and the treatment you need.
• Some Delta Dental plans cover Invisalign treatment.
• Delta Dental plans don’t cover at-home clear aligners.
• Many plans provide some kind of coverage for braces. 
• The cost of orthodontic treatment varies widely by type, brand, and other factors.
• HSAs, FSAs, and financing plans are alternative ways to pay for orthodontic treatment.

How Much Does Delta Dental Cover?

Typically, Delta Dental will cover 50% of Invisalign’s cost, drastically reducing the overall price. Delta Dental also has a $2,000 annual maximum payout and covers 100% of preventive care without a waiting period. This includes:

• Exams
• Cleanings
• Flouride Treatments
• X-rays

It can cover around 80% of basic procedures like fillings. It can also cover 50% of major procedures such as crowns, root canals, and non-surgical extractions.

Does Delta Dental Cover Invisalign?

DeltaCare USA plans don’t cover Invisalign treatment, but Delta PPO plans can cover some of the cost or provide an allowance. It’s best to confirm with Delta Dental which plans cover Invisalign.

Here are two important insurance-related terms to know:

• Non-covered service — a non-covered service or a non-covered expense clause means you won’t have any coverage for Invisalign.
• Limitations and exclusions — specific limitations are offered to people ages 19 and under only, meaning anyone older than 19 is excluded from an orthodontic benefit like Invisalign.

Visit a dentist or orthodontist or call an insurance representative to discuss your Delta Dental orthodontic coverage.

Does Delta Dental Cover At-Home Aligners?

Delta Dental plans don’t cover at-home clear aligners. This includes services from:

• SmileDirectClub
• ALIGNERCO
• NewSmile
• Candid
• Other at-home aligner options

They claim home aligners are a DIY treatment, although this isn’t accurate. Established aligner companies, like SmileDirectClub, work with state-licensed dentists or orthodontists to assess individual cases and develop treatment plans.

DIY orthodontics is a trend where people use household items such as rubber bands to straighten their teeth. These DIY treatments don’t involve a dentist and can cause severe damage.

Delta Dental Court Issue

In June 2020, SmileDirectClub took Delta Dental to court over the issue. SmileDirectClub sued Delta Dental for refusing coverage for home aligners, even though they cover other services, such as teledentistry.²

Delta Dental is holding firm on the matter. It’s currently impossible to receive coverage for home aligners if you’re insured by one of their plans.

Does Delta Dental Cover Braces?

Some plans like DeltaCare USA and Delta PPO provide coverage for:

• Traditional braces
• Lingual braces
• Clear braces

You’ll need treatment from a dentist or orthodontist in Delta’s network to receive your total coverage. Delta Dental may not cover Six Month Smiles braces. Check with Delta Dental to be sure.

Some plans cover more for children than adults. Others have a lifetime limit, which varies depending on the specific plan. Check your plan to determine how much you’ll need to pay out-of-pocket.

Delta Dental Insurance Plans

Delta Dental offers payment plans ranging from $29 to $69 monthly. They offer five individual and family plans, varying depending on your state.

Their insurance plans are:

• Delta Dental PPO — the basic PPO option with lower premiums, a smaller provider network, and low annual maximum/limited coverage.
• Delta Dental PPO Plus Premier — Delta Dental’s top PPO plan with a larger provider network that provides more coverage than the standard PPO.
• Delta Dental Premier — a fee-for-service plan that has the largest provider network; dentists within this network agree to fees for covered services.
• DeltaCare USA (HMO) — focuses on preventive care and restricts you to getting care from network providers only.
• Delta Dental Patient Direct — a program that provides discounted fees when you get care at participating dentists.

Choosing the Best Delta Dental Plan for Orthodontic Coverage

Here are some tips for choosing the best Delta Dental plan for orthodontic coverage:

• Visit the Delta Dental website and view their detailed charts for individual, family, senior, and retiree plans.
• Use Delta Dental’s website search function to look up specific insurance information for your state.
• Consider choosing a plan with orthodontic coverage.
• Remember that Delta HMO plans are more limited than PPO plans, impacting your orthodontic coverage.

How to File a Claim

Filing a claim will vary for different scenarios. Some clinics will handle all the paperwork, while others may require you to do it.

Delta also provides step-by-step instructions online on how to file a claim. According to the website, you’ll need a statement of treatment from your dentist. Be sure to contact their office for it.¹

In-Network Dental Clinics

For in-office treatment like Invisalign and braces, your dentist or orthodontist’s office will file an insurance claim for you. You don’t need to worry about any paperwork.

Out-of-Network Dental Clinics

If you choose a dental office that does not participate with Delta Dental, you may or may not have out-of-network benefits. Here are your options for filing a claim in this scenario:

• Some offices will file for you if you have out-of-network benefits.
• Other offices may request you to pay upfront and file paperwork independently.

Employer-Sponsored Health Insurance

If your employer provides insurance, their HR department may walk you through the process.

Average Cost of Orthodontics Before Insurance

The average costs of orthodontic treatment before insurance are as follows:

Invisalign

The cost of Invisalign starts at $2,800. However, the average cost is between $3,800 and $4,800 for a full Invisalign case.

The final cost depends on various factors, including:

• Treatment length
• Condition severity
• Your dentist’s expertise
• Location

At-Home Aligners

At-home aligners cost between $1,200 and $2,000. They come at a flat rate, which will depend on the company. Examples include:

• SmileDirectClub — $2,050 or $89 per month
• ALIGNERCO — between $945 and $1,195
• Candid — $3,300 (on average, depending on the provider) 
  

Some at-home aligners are partially covered by insurance (but not through Delta Dental).

Braces 

Braces usually cost somewhere between $3,000 and $8,000. The price depends on:

• Condition severity
• Type of braces
• Location
• Your dentist’s rates

The types of braces you can get include:

• Traditional
• Lingual
• Clear
• Ceramic
• Six Month Smiles

Alternative Payment Options 

If your current insurance plan doesn’t cover the orthodontic treatment you want, there are alternative ways to pay:

• Flexible Spending Account (FSA)
• Health Savings Account (HSA)
• Financing Plans

FSA and HSA

FSA and HSA accounts set aside money from your income before taxes and allow you to use it for certain medical and dental expenses. They are often offered by employers and can be used to pay for orthodontic treatment. 

Financing Plans

Financing can also help with orthodontic treatment costs. Many dentists and orthodontists offer payment plans, as will most at-home aligner brands. A credit check may be required to qualify.

There are also third-party options like CareCredit. These options provide financing for medical and dental expenses. They also often require a credit check.

Delta Dental Vs. Other Payment Plans

Delta Dental’s $2,000 annual maximum payout is significantly higher than other dental plans. It also covers several dental procedures and fully covers preventive care.

Delta Dental has no waiting period for preventive care like exams and cleanings. However, there is a 6 month waiting period for basic care benefits and 12 months for major services like crowns. It also has a $10 enrollment fee, while most competitors have no enrollment fee.