Many people wonder if Delta Dental will pay for braces. Braces are an important orthodontic treatment to fix teeth alignment issues. However, dental insurance plans differ in what they cover. This article explains how Delta Dental handles braces coverage, what factors affect payment, and what you should know about related dental health issues like gum disease and sensitive teeth.
What Is Delta Dental?
Delta Dental is one of the largest dental insurance providers in the United States. It offers a variety of dental insurance plans for individuals, families, and employers. These plans often cover preventive, basic, and major dental services. Orthodontic treatment such as braces is usually considered a major service and is sometimes covered with certain limits.
Types of Braces Coverage Under Delta Dental
Delta Dental plans vary by state and employer. Some plans include orthodontic benefits, while others do not. Even among plans with orthodontic coverage, the specifics differ. Here are the typical types of braces coverage you might find:
Orthodontic Coverage for Children: Many Delta Dental plans cover braces for children under 19 years old. This is because many orthodontic problems are best treated during childhood or early adolescence.
Orthodontic Coverage for Adults: Some plans offer limited or no coverage for adult orthodontics. If covered, the benefits might be lower than for children.
Lifetime Maximums: Orthodontic benefits often have a lifetime maximum limit, which means the insurance will only pay up to a certain dollar amount for braces in a lifetime.
Waiting Periods: Some plans require a waiting period before orthodontic benefits begin. This can be several months to a year after plan enrollment.
How Much Will Delta Dental Pay for Braces?
The amount Delta Dental pays depends on your specific plan, the type of braces, and the total cost of treatment. Commonly, Delta Dental covers 50% of orthodontic treatment costs up to the lifetime maximum. For example, if the lifetime orthodontic maximum is $1,500, Delta Dental will pay up to $1,500 for covered braces costs, with you paying the rest.
It is important to check your policy details or contact Delta Dental directly for exact coverage and payment amounts.
Which Types of Braces Does Delta Dental Cover?
Delta Dental usually covers traditional metal braces. Coverage for other types like ceramic braces, lingual braces, or clear aligners (e.g., Invisalign) depends on the plan. Some plans may treat clear aligners as a cosmetic procedure and may not cover them fully or at all. Always verify with Delta Dental before starting treatment.
Steps to Get Braces Covered by Delta Dental
Review Your Policy: Understand your orthodontic benefits, lifetime maximums, waiting periods, and exclusions.
Get an Orthodontic Evaluation: A dentist or orthodontist will assess your need for braces and create a treatment plan.
Pre-Authorization: Submit the treatment plan to Delta Dental for pre-approval. This helps ensure coverage and clarifies your out-of-pocket costs.
Proceed with Treatment: Once approved, you can begin treatment knowing what portion Delta Dental will cover.
What If You Have No Orthodontic Coverage?
If your Delta Dental plan does not cover braces, you can still consider other options:
Flexible Spending Accounts (FSA) or Health Savings Accounts (HSA): Use pre-tax dollars saved for medical expenses to pay for braces.
Payment Plans: Many orthodontists offer monthly payment plans to spread out the cost.
Dental Discount Plans: Some discount plans provide reduced rates for orthodontic treatment.
Alternative Treatments: In mild cases, less costly dental appliances might be used to improve teeth alignment.
How Braces Impact Gum Disease and Sensitive Teeth
Braces can affect your dental health beyond alignment. It is important to understand how braces relate to gum disease and sensitive teeth.
Braces and Gum Disease
Braces make it harder to clean teeth properly. Food particles and plaque can get trapped around brackets and wires. This increases the risk of gum disease. Without careful oral hygiene, gums can become swollen, red, and bleed easily. This is early gum disease called gingivitis. If untreated, it can progress to periodontitis, a serious gum infection that can damage bone and teeth.
Regular dental check-ups, professional cleanings, and proper brushing and flossing techniques are crucial during orthodontic treatment to prevent gum disease.
Braces and Sensitive Teeth
Braces apply pressure to move teeth. This can cause temporary tooth sensitivity, especially after adjustments. The sensitivity usually subsides as teeth adjust. However, if sensitivity is severe or long-lasting, it should be checked by your dentist to rule out cavities or gum issues.
Maintaining Oral Health During Orthodontic Treatment
To ensure the best outcome from braces and protect against gum disease and sensitive teeth, follow these tips:
Brush after every meal using a soft-bristled toothbrush and fluoride toothpaste.
Use floss threaders or interdental brushes to clean between teeth and braces wires.
Consider a mouth rinse recommended by your dentist to reduce plaque and inflammation.
Avoid sugary and sticky foods that increase plaque buildup.
Attend all scheduled dental and orthodontic appointments for monitoring and cleaning.
FAQs
Does Delta Dental cover Invisalign?
Coverage for Invisalign varies. Some Delta Dental plans cover Invisalign as they would traditional braces, but others consider it cosmetic and do not cover it. Confirm with your specific plan.
Is there a waiting period before orthodontic benefits start?
Many Delta Dental plans require a waiting period of 6 to 12 months before orthodontic benefits become active. This prevents people from enrolling just to get immediate braces coverage.
Can Delta Dental pay for braces done outside the U.S.?
Most Delta Dental plans only cover treatments performed by licensed U.S. orthodontists or dentists. International coverage is generally not included.
How to Maximize Your Delta Dental Benefits for Braces
Here are some strategies to get the most out of your Delta Dental coverage for braces:
Enroll in a plan with orthodontic benefits before your child needs braces.
Schedule orthodontic evaluation early to plan treatment during coverage periods.
Submit pre-authorization requests to avoid unexpected denials.
Ask your orthodontist to provide detailed treatment cost estimates and codes to your insurer.
Combine dental benefits with FSAs or HSAs to cover costs exceeding insurance limits.
Conclusion
Delta Dental may pay for braces, but coverage depends on your specific plan, age, type of braces, and lifetime limits. Orthodontic treatment is important for teeth alignment and overall oral health but can influence gum disease risk and cause temporary sensitive teeth. To get braces covered by Delta Dental, understand your policy, obtain pre-authorization, and maintain good oral hygiene during treatment. If your plan lacks orthodontic benefits, consider alternative payment options and consult your dentist for the best approach to your dental health.