Yes, Delta Dental does cover crowns in most of its plans, but the level of coverage depends on your specific plan.
You’ve been told you need a dental crown, and now you’re wondering what it’s going to cost you.
For many patients, that’s where the real anxiety starts. Dental crowns are common and incredibly effective, but they’re not cheap. So naturally, the next question is: Does my insurance, specifically Delta Dental — cover it?
Let’s break it all down in plain, clear language. We’ll look at what Delta Dental typically covers, how coverage differs across plan types, what to do if your crown isn’t covered, and how to make the smartest financial decision for your dental care.
Key Takeaways
✔ Most Delta Dental plans cover crowns as a major restorative service
✔ PPO plans typically cover 50% after deductible, with waiting periods and frequency limits
✔ DeltaCare USA plans offer fixed copays for specific crown types
✔ Cosmetic crowns are not usually covered unless they also restore function
✔ If your crown isn’t covered, ask about pre-determinations, alternative materials, or payment plans
Not sure if you are covered? At Humble Memorial Dental Group, we accept most insurances. Talk to your humble dentist today and see what dental insurance we accept.
What Are Dental Crowns, and Why Might You Need One?
A dental crown is a cap placed over a damaged, weak, or misshapen tooth to restore its structure, strength, and appearance. You might need a crown if:
- You’ve had a root canal
- Your tooth has a large cavity or filling
- Your tooth is cracked or broken
- You’re getting a dental bridge
- You want to cover a discolored or misshapen tooth
In short, crowns aren’t optional fluff. They’re often essential for saving your natural tooth and avoiding more invasive treatment down the line.
Does Delta Dental Cover Crowns?
Yes, Delta Dental does cover crowns in most of its plans, but the level of coverage depends on your specific plan.
Crowns typically fall under major restorative services, which often come with different rules than cleanings or fillings. Here’s what you need to know:
- Most PPO plans cover 50% of the cost of a crown after you meet your deductible.
- Many HMO-style plans (like DeltaCare USA) offer fixed copays for crowns.
- Crowns must usually be deemed medically necessary, not cosmetic.
Delta Dental PPO: How Crown Coverage Works
If you have a Delta Dental PPO plan, here’s how crown coverage typically plays out:
- Coverage Percentage: Usually 50%, after deductible
- Waiting Period: Many plans require a 12-month wait for major services
- Frequency Limits: Crowns are often only covered once every 5 years per tooth
- Medical Necessity: Your dentist may need to submit documentation or X-rays showing that the crown is necessary
Example Scenario:
You need a porcelain crown on a molar. Your Delta PPO plan includes 50% coverage for major services, and you’ve already met your deductible. If the crown costs $1,200, Delta might pay $600, and you pay the other $600.
But let’s say you had a crown on that same tooth three years ago. Even if the tooth is cracked again, your plan may deny coverage due to frequency limitations.
DeltaCare USA: Crown Coverage at a Copay
DeltaCare USA is Delta Dental’s HMO-style plan. It works differently:
- You must choose a primary dentist in-network
- Coverage is based on a copay schedule, not percentages
- Crowns may have a fixed cost (e.g., $300 for a porcelain-fused-to-metal crown)
- You usually don’t have to deal with deductibles or waiting periods
Pros:
- You know exactly what you’ll pay upfront
- Typically lower out-of-pocket cost
Cons:
- Fewer choices in crown materials
- Limited to providers in your assigned network
Your out-of-pocket might be lower with DeltaCare, but you trade flexibility for affordability.
Are Cosmetic Crowns Covered?
That depends. If your crown is being placed for cosmetic reasons only (like changing the color or shape of a tooth), there’s a good chance your insurance will not cover it.
However, if your crown is being placed to restore function (like after a root canal or due to decay), it’s usually covered.
Pro tip: Ask your dentist to include clinical notes and photos when submitting to insurance. More documentation = better chance of approval.
How Much Do Crowns Cost With and Without Insurance?
Let’s talk numbers:
Without Insurance:
- Porcelain-fused-to-metal crown: $900–$1,500
- All-ceramic or all-porcelain crown: $1,000–$2,000
- Gold crown: $1,200–$2,500
With Delta Dental PPO:
- If 50% is covered and your deductible is met, you might pay $500–800 out of pocket
With DeltaCare USA:
- Copays range from $250–500 depending on crown type and location
What to Do If Your Crown Isn’t Covered
If your crown isn’t covered, don’t panic. There are several steps you can take to manage the situation and still move forward with treatment.
1. Ask for a Pre-Determination
Before your dentist starts any work, request a pre-treatment estimate from Delta Dental. This gives you a clear picture of what’s covered, what’s not, and what you’ll owe—so there are no surprises after the fact.
2. Explore Alternative Materials
Sometimes insurance won’t cover certain crown materials, like all-ceramic, but will partially cover a porcelain-fused-to-metal crown. Your dentist can walk you through material options that are both cost-effective and clinically appropriate.
3. Consider Phased Treatment
If full coverage isn’t available now, ask your dentist if it’s possible to temporarily protect the tooth until your benefits reset or you’re eligible for plan upgrades. Temporary fillings or build-ups can often buy time.
4. Ask About Payment Plans
Many dental offices offer in-house financing or partner with companies like CareCredit to let you pay over time. This can help you get the care you need now while managing your budget.
5. Consider a Plan Upgrade
If your plan doesn’t offer enough crown coverage and you anticipate more dental work in the future, it might be worth upgrading during your next open enrollment period. Look for a plan with a higher annual maximum or more coverage for major services.
6. Check for Health Savings or Flexible Spending Accounts
If you have an HSA or FSA, these funds can typically be used toward crown procedures—even if insurance doesn’t cover the full amount.
The bottom line: There are ways to work around limited coverage. Your dental team can help you explore them.
Final Thoughts: Yes, Delta Dental Covers Crowns, But Know the Fine Print
Crowns are a smart, long-term fix for many dental issues. And while Delta Dental does offer coverage, understanding the details of your plan is the key to avoiding unexpected costs.
Always ask your dentist to verify benefits before treatment. And if you’re not sure what your plan covers, call Delta Dental or check your Summary of Benefits document.
Looking for Dental Crowns in Humble? Speak to any of our doctors today!
