Does Delta Dental Cover Clear Aligners & Braces?

It’s no secret that orthodontic treatment is expensive. A quick Google search for the average price of Invisalign or braces will send most people looking for financial assistance. For some, that assistance comes in the form of insurance. But every insurance provider and plan is different. Some include orthodontic benefits, while others don’t. Understanding the details of your specific plan will help you know how much you might have to pay.

If you have Delta Dental, there’s a chance that you’ll receive coverage for clear aligners or braces, but it depends on your plan and treatment. Before you dive in, read this guide for an in-depth look at Delta’s coverage and instructions on how you can use it.

Delta Dental Invisalign Coverage

Certain Delta plans will cover Invisalign treatment, but others won’t. Some Delta PPO plans might cover a percentage of the treatment cost. How much they cover depends on the plan, but it can be around 50% for children and adults. You’ll likely need to go to a dentist or orthodontist that’s in-network with Delta to receive coverage.

Most DeltaCare USA plans, on the other hand, will not cover Invisalign treatment.

Since ClearCorrect, SureSmile, and 3M Clarity Aligners are similar to Invisalign, they might also qualify for partial coverage, depending on your plan. Six Month Smiles typically treats milder cases, so it’s more often considered a cosmetic procedure, but not always! You’ll have to check with the company and your dentist to find out.

Delta Dental Braces Coverage

The coverage for braces is slightly broader. Many plans — whether DeltaCare USA or Delta PPO — will provide some sort of coverage for braces. Some plans cover more for children than adults, and others have a lifetime limit, although they vary based on the specific plan. So, you’ll need to check your plan details to find out how much you’ll need to pay out of pocket.

Lingual braces and ceramic braces fall into the same boat since they’re used to treat the same kinds of conditions. Six Month Smiles, however, usually treats milder, cosmetic cases, so they might not be covered. You’ll need to check with Delta to find out.

Remember that you’ll need to get treatment from a dentist or orthodontist in Delta’s network to receive the full amount for your coverage.

Delta Dental At-Home Clear Aligners Coverage

Delta Dental has stated that their plans will not cover at-home clear aligners. If you have a Delta plan, you shouldn’t expect to receive any assistance paying for your at-home treatment.

In fact, SmileDirectClub took them to court over it, suing Delta Dental Plans Association, Delta Dental of Illinois Foundation, and Delta Dental of California for denying coverage for home aligners even though they cover other teledentistry methods.

Delta calls home aligners a “DIY treatment,” but that’s not accurate. Popular aligner providers, including Byte and SmileDirectClub, assign a state-licensed dentist or orthodontist to create individualized treatment plans. DIY orthodontics, on the other hand, is a concerning trend where people use household items like rubber bands or self-designed 3D printed aligners to shift their teeth without any dentist involvement, and it can cause serious damage.

That said, Delta Dental is currently holding firm on the matter, so you won’t receive coverage for home aligners on one of their plans unless they change their policy.

Average Costs Before Insurance

What are these startling orthodontic prices we mentioned? They can vary significantly based on your condition’s severity, your dentist or orthodontist’s rates, and the type of treatment you choose.

Invisalign

On average, your Invisalign treatment will cost somewhere between $3,000 and $8,000. That’s a pretty big range, but only because the price is subject to several influencing factors. Your condition’s severity, treatment length, dentist’s expertise, and even where you live can affect your final price. Read through our true cost of Invisalign guide for a closer look.

Although Invisalign pioneered mainstream clear aligner treatment, they’re no longer the only producer. ClearCorrect hit the scene in 2006 and has been a worthy competitor ever since. They charge less for lab fees than Invisalign does, so their prices can be slightly lower, often in the $3,000–$5,000 range (although up to $8,000 is possible too). Then there’s SureSmile, who offers an affordable, highly customizable alternative that typically costs $2,000–$6,000, and 3M Clarity, who makes some of the most powerful aligners out there and often costs $3,000–$8,000.

At-Home Clear Aligners

While Invisalign must be administered in a dentist or orthodontist’s office, at-home aligners let you complete treatment (you guessed it) at home. A remote dentist will design your treatment and you’ll receive all of your aligners in the mail, then follow your treatment plan to gradually shift your teeth.

The appeal of at-home clear aligners is largely because of their affordability. They’re often thousands cheaper than in-office clear aligner treatments, costing around $1,200–$2,500 on average. Unlike in-office options, home aligners come at a flat rate. The only difference is which company you choose. For example, SmileDirectClub is always $2,250, while AlignerCo is $995.

Our top-ranked provider is Byte, which costs $1,999 for standard treatment and $2,399 for Byte At-Night. They don’t have the absolute lowest price on the market, but they claim their average treatment plan length is just 4–5 months, and they put a lifetime guarantee on your smile. Plus, Byte will walk you through the entire insurance process, from initial coverage checks to claims and anything else you might need, making it a lot easier. Check out our guide on insurance coverage with Byte for more info.

Braces

The most time-tested orthodontic treatment can also be one of the most expensive. Traditional braces typically fall somewhere in the $4,000–$6,000 price range, although that price depends on a few factors (see our guide on the true cost of braces). Like Invisalign, the exact amount depends on the severity of your condition, your orthodontist’s rates, and where you live.

It also depends on the type of braces you choose. You have a few options: traditional braces, lingual braces (which sit behind the teeth), and clear/ceramic braces. Specialty braces (lingual, clear) often cost more than traditional ones. Lingual braces, for example, can cost up to $10,000.

What Does Dental Insurance Usually Cover?

Insurance companies often classify dental procedures into one of four categories: preventive, basic, major, and cosmetic.

Most plans cover 100% of your preventive treatments like cleanings. They might also completely cover basic treatments like fillings, gum disease treatment, and root canals, or they might cover a higher percentage of the price. Major treatments like crowns and bridges are usually covered at a lower rate, sometimes around 50%. Plans will rarely cover cosmetic procedures, like whitening, veneers, and tooth shaping. Of course, the percentages for each category depend on your specific plan.

Notably, some providers consider clear aligners and braces cosmetic forms of treatment, and others classify them as major procedures. Some plans will include orthodontic benefits that can help cover the cost of braces, aligners, or other procedures, while others do not.

Different providers and plans cover different procedures, so you shouldn’t assume that you’ll receive coverage for your treatment just because you have orthodontic benefits. Additionally, sometimes this coverage comes with an age limit or an annual or lifetime limit.

It’s also important to know some insurance terminology to understand your plan, like:

• Deductible: The amount you’ll need to pay out of pocket before insurance picks up the tab. If you have a $100 procedure, but your deductible is $500 and you haven’t paid any of it yet, you’ll need to pay for the entire procedure.
• Copay: Short for copayment. A set amount that you’ll pay for certain covered treatments. Copays can vary based on the procedure.
• Coinsurance: The percentage of treatment costs you’ll need to cover after you’ve met your deductible. It also varies based on the procedure.
• In-Network vs. Out-of-Network: Dental providers often partner with insurance companies to provide “in-network” coverage. When your dental provider is in-network with your insurance provider, coverage rates are typically higher and your dental provider will handle the insurance paperwork for you. Coverage rates for out-of-network care are often lower, and you may need to request reimbursement from your insurance provider directly.

How to Get Orthodontic Coverage with Delta Dental

Orthodontic coverage isn’t something you need to buy separately — it’s simply included in certain Delta Dental plans. There are two ways to get enrolled in a suitable Delta Dental plan: through your employer or by purchasing an individual plan.

The most common way to get dental insurance in the U.S. is through an employer — either your own or that of your spouse. This option comes with a few advantages, the biggest of which is getting the cost of your premiums deducted directly from your wages, preventing that income from being taxed. In many cases, employers will also help pay for the cost, lowering your expenses.

Employer-sponsored dental plans also come with drawbacks. The most prominent one is that you’re limited to the plans your company offers. If their plans don’t cover orthodontics or have other unfavorable terms, you either shop around or take the deal.

Another issue that pops up with employer-sponsored dental plans is the open enrollment period. This means you have to wait for a specific time of year to take out a policy. Finally, your employer might not offer dental insurance at all.

If you don’t have the option of an employer-sponsored dental plan, or the ones offered don’t fit your needs, you can take out an individual plan. Delta Dental issues individual plans in most states, but before you lock in, compare their rates and terms with those of other insurance companies.

How to File a Claim

For in-office treatments like braces and Invisalign, your dentist or orthodontist’s office will file an insurance claim on your behalf, so you don’t have to worry about any paperwork or other correspondence. They’ll only do this, however, if they are “in-network” with Delta. If you choose an out-of-network dentist or orthodontist, you may need to file the claim yourself. If you receive insurance through your employer, their human resources department can walk you through the process.

Fortunately, Delta provides plenty of information on filing claims. You will need a Statement of Treatment from your dentist, so be sure to get that information from their office.

After you’ve filed a claim, the insurer will process it, which can take anywhere from a few weeks to a couple of months.

Other Options if You’re Not Covered

What if you’re ready to get started with braces or aligners, but your current insurance plan doesn’t cover the treatment you want?

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use either to pay for your treatment. These accounts deduct money from your income before taxes and let you use it for qualifying medical and dental expenses. They’re often an option with employer-sponsored plans, and even if you received partial coverage for your orthodontic treatment from Delta, you could use an HSA or FSA account to pay the remaining balance.

Otherwise, you can look for other ways to make the price tag more manageable, like financing plans. Dentist and orthodontist offices will usually offer payment plans, as will most at-home aligner companies, although a credit check might be necessary to qualify. Or, you can check out third-party options just be sure to research these carefully and read the fine print, as these plans usually include interest which will increase your overall cost — in some cases, significantly so.

Final Thoughts

The top takeaway is that you can receive coverage for your adult orthodontic treatment. Delta Dental has a pretty good track record of covering braces and Invisalign (compared to other insurers) if your plan includes orthodontic benefits. But if you’re set on at-home aligner treatment, you probably won’t receive any assistance, so you may need to examine other options.

Insurance can sometimes seem like an enigma, especially when it comes to orthodontics. But once you know the ins and outs of your plan, you should have a good idea about which treatments will receive coverage and how you can take advantage. It’s always a good idea to consult your dentist, orthodontist, or at-home aligner provider about insurance coverage before diving into treatment.