Does Delta Dental Cover Invisalign?

Key Takeaways

• If you have Delta Dental, you may have orthodontic coverage depending on the type of plan you have and the treatment you need.
• Some Delta plans cover Invisalign treatment. Others don’t.
• 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.

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 for it. It’s best to confirm with Delta Dental which plans cover Invisalign. Here are two insurance-related terms you should know about:

• 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: There may be a clause that states that orthodontic benefits are offered to people ages 19 or under only. This specific limitation excludes all insured members over the age of 19 from receiving the orthodontic benefit, including coverage for Invisalign treatment.

You’ll likely need to visit a dentist or orthodontist that’s in-network with Delta for coverage.

Does Delta Dental Cover At-Home Aligners?

Delta Dental plans don’t cover at-home clear aligners. This includes services from: They claim that home aligners are a DIY treatment, although this isn’t accurate. Established aligner companies, like Byte and SmileDirectClub, work with state-licensed dentists or orthodontists to assess individual cases and develop treatment plans for people. DIY orthodontics is a trend where people use household items such as rubber bands to try 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 not currently possible 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 to receive treatment from a dentist or orthodontist in Delta’s network to receive the total amount of your coverage. Delta Dental may not cover Six Month Smiles braces. Be sure to check with Delta Dental to find out. Some plans cover more for children than adults. Others have a lifetime limit, but this varies depending on the specific plan. You’ll need to check your plan to determine how much you need to pay out-of-pocket.

Average Cost of Orthodontics Before Insurance

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

Invisalign

Invisalign treatment costs between $3,000 and $8,000. 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. Here are a few examples:

• SmileDirectClub cost: $2,050
• ALIGNERCO cost: between $945 and $1,145
• Byte cost: between $1,999 and $2,399
• 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 $4,000 and $10,000. The price depends on:

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

The types of braces you can get include:

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
• Utilize Delta Dental’s website search function to look up specific insurance information for your state
• Consider choosing a plan with orthodontic coverage
• Keep in mind 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 for you, while others may require you to do it yourself. 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 your insurance, their HR department may walk you through the process.

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 or HSA

FSA or 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 most at-home aligner brands will. 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.