Yes, Delta Dental covers braces, but it depends on your specific plan, your age, and the type of treatment you’re seeking.
Orthodontic care isn’t just about aesthetics. Braces can improve jaw alignment, ease pain, and prevent future dental complications. If you’re considering them for yourself or your child, it’s critical to understand what your Delta Dental plan will cover.
This guide explains everything you need to know before starting treatment, especially when insurance fine print feels like a second language.
Key Takeaways
✔ Delta Dental covers braces under many PPO and DHMO plans
✔ Most orthodontic benefits are for children under 19
✔ Invisalign is only covered under specific PPO plans
✔ Adult coverage is limited, but possible under premium or employer-sponsored plans
✔ Humble Memorial Dental helps verify coverage and create custom financing solutions
What Are Braces and Why Might You Need Them?
Braces are commonly used to correct dental issues like misaligned teeth, crowding, overbites, underbites, and spacing problems. While many associate them with teenagers, braces are often needed by adults too. Left untreated, alignment issues can lead to headaches, TMJ disorders, poor oral hygiene, and more expensive dental work later.
Does Delta Dental Cover Braces? The Short Answer
Yes, but not all plans include orthodontic coverage. Here’s the breakdown:
- Most coverage is geared toward children under 19.
- Adults are only covered under specific PPO or group plans.
- Braces must be medically necessary in many cases.
- Coverage might include traditional braces, and in limited cases, Invisalign.
Delta Dental PPO Plans: Coverage for Braces
Delta Dental’s PPO plans offer more flexibility and coverage than DHMO plans. Here’s what to expect:
- Typically covers 50 percent of orthodontic costs.
- Subject to a lifetime orthodontic maximum, usually between $1,000 to $2,500 per person.
- May have a waiting period of 6 to 12 months.
- Invisalign may be covered under high-tier plans, especially for teens.
- Pre-treatment authorization and documentation from your orthodontist are usually required.
This type of plan is ideal for families who anticipate orthodontic care and want provider flexibility.
DeltaCare USA (DHMO): Fixed Fees, Limited Options
DeltaCare USA is a DHMO-style plan that trades flexibility for affordability.
- Instead of percentage-based reimbursement, it uses a copay schedule.
- Must see an assigned in-network orthodontist.
- Coverage usually excludes Invisalign, ceramic, and lingual braces.
- Copays for traditional braces generally range from $1,500 to $2,500.
Good for predictable costs, but options are limited and choice of providers is narrower.
Does Delta Dental Cover Braces for Adults?
Orthodontic benefits are usually aimed at dependents under 19. However, some premium PPO and group plans include adult orthodontic coverage, especially when there’s a documented medical reason like:
- TMJ disorders
- Jaw misalignment
- Difficulty chewing or speaking
Even with coverage, adults will likely pay more out-of-pocket, and Invisalign is rarely included unless specified.
What Types of Braces Might Be Covered?
- Metal braces: Most commonly covered across PPO and DHMO plans.
- Ceramic braces: Sometimes covered under premium PPOs.
- Lingual braces: Almost never covered.
- Invisalign: Covered in select PPO plans, usually for teens, not adults.
Each plan is different, so it’s essential to read your benefits guide or contact Delta Dental directly.
What’s the Cost of Braces With vs. Without Delta Dental?
Without Insurance:
- Metal braces: $3,000 to $7,000
- Invisalign: $4,000 to $8,000
- Lingual or ceramic braces: $5,000 to $10,000+
With Delta Dental PPO:
- Covers up to 50 percent of cost, capped by the lifetime ortho max.
- Patient responsibility: $2,000 to $4,000, depending on the plan.
With DeltaCare USA:
- Flat-rate copays ranging from $1,500 to $2,500
What Is a Lifetime Orthodontic Maximum?
This is a one-time cap on what Delta Dental will pay toward orthodontic treatment, separate from your annual benefit maximum.
- Usually between $1,000 to $2,500.
- Applies per person, not per year.
- Once used, it doesn’t reset.
Plan accordingly if multiple family members need treatment.
How to Know If Your Plan Covers Braces
You don’t need a crystal ball. Just:
- Review your Summary of Benefits
- Ask your dentist to submit a pre-treatment estimate
- Look for plan terms like “orthodontic services,” “dependent child,” or “adult orthodontia”
Still unsure? Call Delta Dental or check your account online.
How to Maximize Your Delta Dental Braces Coverage
- Start treatment before your child turns 19 to avoid aging out.
- Stick to in-network orthodontists.
- Use pre-authorization to avoid surprises.
- Time your treatment with benefit periods for cost planning.
- Use FSA or HSA funds for any out-of-pocket payments.
What to Do If Braces Aren’t Covered
1. Explore Discount Dental Plans
These may offer reduced pricing on orthodontic care, especially for adults.
2. Use In-House Financing
At Humble Memorial Dental, we offer monthly payment plans and partner with CareCredit to make treatment accessible.
3. Consider Alternative Treatments
Retainers, partial aligners, or early intervention techniques can reduce total costs.
4. Appeal With Medical Documentation
If braces correct bite issues or relieve TMJ, submit medical justification for possible exception.
Looking for Braces in Humble, TX?
At Humble Memorial Dental, we provide full-service orthodontics for kids, teens, and adults. We:
- Accept Delta Dental PPO and DeltaCare USA
- Offer clear, upfront pricing and no surprise bills
- Handle insurance pre-approvals and paperwork
- Provide flexible payment options tailored to your budget
Schedule your consultation today and let’s get started on a straighter, healthier smile.
Conclusion
Yes, Delta Dental does cover braces. Just how much depends on your plan, your age, and the type of braces you’re considering. PPO plans offer more coverage and flexibility, especially for teens. DHMO plans are more budget-friendly but have tighter restrictions.
The key is knowing what your plan includes, planning your treatment carefully, and working with a dental team that can guide you through it all. When done right, insurance can turn an expensive treatment into an affordable investment.
