Yes, Delta Dental does offer coverage for dentures, but the level of coverage depends on the plan type you have.
Getting dentures isn’t just a dental decision, it’s a financial one, too. Dentures can be life-changing, restoring your smile, confidence, and ability to eat the foods you love. But let’s be honest: they’re not cheap.
If you’re covered by Delta Dental, you’re probably asking the right question: “Does Delta Dental cover dentures?”
The short answer is yes, but the details matter. In this guide, we’ll break down what kinds of dentures Delta Dental covers, how much you might pay, and what to do if you find yourself stuck with a big bill.
Key Takeaways
✔ Most Delta Dental PPO plans cover 50% of denture costs after the deductible
✔ DeltaCare USA offers predictable copays, often between $350–$600 per arch
✔ Coverage depends on plan details, frequency limits, and medical necessity
✔ Implant-supported dentures are rarely covered under basic plans
✔ Patients can use HSAs, FSAs, payment plans, and smart scheduling to manage costs
What Are Dentures and When Are They Needed?
Dentures are removable prosthetic devices used to replace missing teeth. They come in different forms depending on how many teeth need replacing:
- Complete (Full) Dentures: Replace all teeth in the upper or lower jaw
- Partial Dentures: Replace several missing teeth while preserving the rest
Common reasons for needing dentures include:
- Extensive tooth loss due to decay or gum disease
- Trauma or injury
- Bone loss in the jaw
- Age-related dental deterioration
Dentures are more than a cosmetic fix, they’re a practical solution to restore chewing ability, prevent shifting of remaining teeth, and support facial structure.
Does Delta Dental Cover Dentures?
Yes, Delta Dental does offer coverage for dentures, but the level of coverage depends on the plan type you have.
Dentures usually fall under major restorative services, which are covered differently from basic procedures like cleanings or fillings. Here’s the breakdown:
- PPO Plans: Typically cover 50% of the cost after the deductible
- DeltaCare USA Plans (HMO): Use a copayment schedule with set fees for dentures
But there are always variables: waiting periods, annual maximums, frequency limits, and what type of denture is being recommended.
Coverage Breakdown by Plan Type
1. Delta Dental PPO Plans
If you’re on a Delta Dental PPO plan, dentures are generally covered as a major service, meaning:
- Coverage: Usually 50% after deductible is met
- Waiting Period: Commonly 6 to 12 months for new enrollees
- Annual Maximums: Typically $1,000–$2,000 total per year
- Frequency Limits: Dentures may only be replaced every 5–7 years per arch
- Pre-authorization: May be required for full coverage to apply
What’s Typically Covered:
- Initial denture appliance (full or partial)
- Denture repairs and relines
- Adjustments (within a specified timeframe post-fitting)
What Might Not Be Covered:
- Premium materials or upgraded finishes
- Duplicate appliances
- Cosmetic-only replacements
2. DeltaCare USA (HMO Plans)
DeltaCare USA is Delta Dental’s HMO-style plan. These work with a set copayment schedule and require you to use a designated in-network dentist.
- Coverage: Copays for dentures typically range from $350 to $600 per arch
- Waiting Period: Usually none
- Deductibles: Often not applicable
- Flexibility: Lower, as you’re limited to specific providers and material types
Benefits:
- Predictable pricing
- No claims to file
- Affordable entry point for many patients
Drawbacks:
- Less choice in materials or customizations
- Fewer dentist options due to network requirements
Are Immediate or Implant-Supported Dentures Covered?
Immediate Dentures
These are placed right after tooth extractions to provide temporary function and aesthetics during healing. Coverage varies:
- Sometimes covered, but documentation may be required to show they’re medically necessary
- Often viewed as part of the full denture package
Implant-Supported Dentures
These are dentures that attach to dental implants for enhanced stability. They’re popular but usually not covered under standard plans unless your employer offers a more comprehensive benefit package.
- PPO plans: May partially cover the denture, but not the implants themselves
- DeltaCare USA: Typically does not cover implant-supported options
If you’re interested in this option, your best bet is to check for supplemental or upgraded plans, or prepare for out-of-pocket costs.
Is Denture Replacement Covered?
Yes, but it’s limited.
Most Delta Dental plans allow denture replacement every 5–7 years, assuming the appliance is worn or no longer fits properly. You may need to provide:
- Updated X-rays or dental records
- Clinical notes showing deterioration or poor fit
Early replacement without medical necessity is often denied.
Estimated Denture Costs With vs. Without Delta Dental
Without Insurance:
- Full dentures: $1,000 to $3,000 per arch
- Partial dentures: $700 to $1,800
- Implant-supported dentures: $5,000 to $30,000
With PPO Coverage:
- You’ll pay 50% after meeting your deductible
- Example: If a denture costs $1,500, and you’ve met your deductible, you’ll pay ~$750
With DeltaCare USA Copays:
- Typically between $350 and $600 per arch, depending on plan and region
Remember, these prices don’t always include extras like follow-ups, relining, or repairs, which may incur additional charges.
What to Do If Dentures Aren’t Covered
Even if you get a denial or partial approval, you’ve still got options:
1. Request a Pre-Treatment Estimate
This gives you an upfront view of what Delta Dental will cover before the procedure. Your dentist submits a treatment plan, and you’ll get a breakdown of your financial responsibility.
2. Ask Your Dentist About Alternatives
There may be more affordable options depending on the materials and method used (e.g., acrylic vs. metal framework). Ask your provider to tailor treatment to your plan.
3. Consider Phased Treatment
If the full procedure isn’t covered at once, ask if it can be staged over multiple benefit years or begin with a partial solution until coverage resets.
4. Use an HSA or FSA
Flexible Spending Accounts and Health Savings Accounts can cover dentures—even if your plan doesn’t. These accounts offer tax-free funds for out-of-pocket dental expenses.
5. Inquire About Payment Plans
Most dental offices offer monthly installment plans to spread out the cost of dentures over time. Third-party financing like CareCredit is also commonly accepted.
6. Evaluate Your Insurance Plan
If you expect ongoing dental needs, it may be time to explore a plan upgrade during your next open enrollment period.
Tips to Maximize Denture Coverage
Want to make sure you get the most out of your dental plan? Here’s how:
- Always use in-network providers
- Ask your dentist to submit documentation and X-rays for pre-approval
- Stay current with annual checkups to avoid lapses in coverage
- Understand your plan’s annual maximum and time limits on replacements
- Schedule procedures around benefit resets to make the most of yearly coverage
Looking for Affordable Dentures in Humble, TX?
At Humble Memorial Dental, we’re here to make the denture process straightforward and stress-free. We:
- Work with Delta Dental PPO and DeltaCare USA plans
- Help patients understand their coverage and maximize their benefits
- Offer flexible payment options and phased treatment when needed
Visit our humble dental clinic today, and let’s build your treatment plan around what makes sense for your smile, and your budget.
Final Thoughts
Dentures can improve your quality of life, and yes, Delta Dental often helps cover the cost. But the key is understanding the fine print: your plan type, your deductibles, and the specific type of denture you’re getting.
When in doubt, ask questions, get a pre-treatment estimate, and work with a dental provider who knows how to navigate insurance. Because restoring your smile shouldn’t come with financial stress.
