Let me cut straight to the chase on a question I hear almost daily at my Beverly Hills practice: does Delta Dental PPO cover braces?
The short answer: Yes, Delta Dental PPO does cover braces—but with important limitations you need to understand before starting treatment.
As someone who’s helped thousands of Los Angeles patients navigate their dental insurance for orthodontic work, I’ll break down exactly what you need to know about Delta Dental PPO orthodontic coverage.
Delta Dental PPO Orthodontic Coverage: The Bottom Line
Delta Dental PPO plans do cover braces, but coverage varies significantly based on your specific plan:
- Most plans cover 50% of orthodontic treatment costs
- Lifetime maximums typically range from $1,000-$2,000
- Many plans only cover dependents under age 19
- Adult coverage is available but less common
According to the American Dental Association, only about 43% of dental insurance plans provide comprehensive orthodontic coverage for adults over age 19.
| Delta Dental PPO Plan Type | Adult Coverage | Coverage Percentage | Lifetime Maximum | Waiting Period |
|---|---|---|---|---|
| DeltaCare USA | Yes | 50% | $1,500-$2,000 | None |
| Delta Dental PPO | Varies by plan | 50% | $1,000-$1,500 | 12 months |
| Delta Dental Premier | Rarely | 35-50% | $1,000 | 12-24 months |
| Delta Dental Basic | No | 0% | $0 | N/A |
Which Delta Dental PPO Plans Cover Adult Braces?
From my experience serving patients from Malibu to Downtown LA, these Delta Dental plans typically offer the best adult orthodontic coverage:
Delta Dental PPO Plus Premier
This plan almost always includes some orthodontic coverage for adults.
The average coverage is 50% up to a $1,500 lifetime maximum.
DeltaCare USA
Though technically a DHMO rather than a PPO, this plan offers set copayments for orthodontic treatment.
Adult braces typically cost $1,500-$2,500 out-of-pocket with this plan (compared to $4,000-$6,000 without insurance).
Delta Dental PPO Value
About 60% of these plans include adult orthodontic benefits.
Coverage is typically 50% up to a $1,000 lifetime maximum.
Adult vs. Child Coverage: What’s Different?
Just last week, a family from near the Hollywood Bowl came in assuming their Delta Dental PPO would cover braces the same way for everyone in the family.
They were surprised to learn the significant differences:
- While 92% of Delta plans cover orthodontics for children under 19, only about 35% cover adults
- Adult coverage typically has a 12-month waiting period
- Lifetime maximums are often $500-$1,000 lower for adults
- Some plans require using in-network orthodontists for adult coverage
According to the Journal of the American Dental Association, insurance companies offer more limited adult coverage because approximately 75% of adult orthodontic cases are considered primarily cosmetic rather than medically necessary.
What Counts as “Medically Necessary” for Delta Dental?
For Delta Dental to consider your braces medically necessary (which can improve coverage), your case typically needs one or more of these conditions:
- Severe overbite or underbite affecting function
- Crossbite causing damage to teeth or gums
- Impacted teeth requiring orthodontic intervention
- Crowding or spacing that significantly impacts oral health
- TMJ disorder directly related to malocclusion
Research from the American Association of Orthodontists indicates only about 30% of adult cases meet these criteria.
Typical Costs for Braces With Delta Dental PPO Coverage
Based on treating hundreds of patients in our Westwood practice, here’s what you can expect to pay in the Los Angeles area:
Traditional Metal Braces
- Average cost without insurance: $4,500-$6,000
- With Delta Dental PPO (50% coverage): $2,250-$3,000 plus any amount over your maximum
Ceramic Braces
- Average cost without insurance: $5,500-$7,000
- With Delta Dental PPO (50% coverage): $2,750-$3,500 plus any amount over your maximum
Invisalign
- Average cost without insurance: $5,000-$8,000
- With Delta Dental PPO (50% coverage): $2,500-$4,000 plus any amount over your maximum
Real-World Example: Delta Dental Coverage in Action
A tech executive from Silicon Beach recently visited our Santa Monica location for Invisalign treatment.
Her Delta Dental PPO Plus Premier plan covered:
- 50% of the $6,200 treatment cost
- Up to a $1,500 lifetime maximum
- With no waiting period (she’d been on the plan for over 2 years)
Her final out-of-pocket cost: $4,700 ($6,200 – $1,500 insurance coverage)
We were able to reduce this further with our in-house financing options.
How to Check Your Specific Delta Dental PPO Coverage
Before scheduling your consultation at our Beverly Hills office, I recommend:
- Call Delta Dental at the number on your insurance card
- Request verification of your “adult orthodontic benefits”
- Ask specifically about:
- Coverage percentage for braces/Invisalign
- Lifetime maximum benefit
- Remaining benefit (if you’ve used orthodontic benefits before)
- Waiting period requirements
- In-network provider requirements
Alternatively, our dedicated insurance coordinator can verify your benefits before your appointment—just provide your policy information when scheduling.
Alternative Payment Options When Delta Dental Coverage Falls Short
If your Delta Dental plan doesn’t provide adequate coverage, don’t worry. At our practice near The Grove, we offer:
- 0% interest payment plans for up to 24 months
- 5% discount for payment in full
- FSA/HSA acceptance for orthodontic treatment
- Special financing through CareCredit and Lending Club
- Seasonal promotions (we’re currently offering $750 off Invisalign for new patients)
Why Choose Our Practice for Braces Despite Insurance Limitations
Even with limited Delta Dental coverage, there are compelling reasons to choose our practice for your orthodontic needs:
- Same-day emergency appointments
- Evening and weekend hours for busy professionals
- Digital scanning (no messy impressions)
- Virtual consultations available for those in West Hollywood, Brentwood, and beyond
- Proven results with thousands of successful cases throughout Los Angeles
Understanding Delta Dental’s “In-Progress” Treatment Policy
A critical factor many patients from Venice Beach to Los Feliz don’t realize: Delta Dental handles “in-progress” orthodontic treatment differently than most insurers.
If you begin treatment before your coverage starts:
- Some plans will provide pro-rated benefits based on remaining treatment
- Others won’t cover any portion of treatment that began before the effective date
- Most require submission of the original banding date and total treatment cost
According to Delta Dental’s own policy documentation, approximately 65% of their plans offer some form of coverage for treatment in progress.
FAQs About Delta Dental PPO Coverage for Braces
Does Delta Dental PPO cover Invisalign the same as traditional braces?
Yes, most Delta Dental PPO plans that cover orthodontics treat Invisalign the same as traditional braces. However, the lifetime maximum applies regardless of the type of braces you choose.
How do I know if I’m in my waiting period for orthodontic coverage?
Delta Dental PPO plans typically have a 12-month waiting period for orthodontic services. You can verify your specific waiting period by calling the customer service number on your insurance card or asking our office to check for you.
Will Delta Dental cover braces if I already have them on?
It depends on your specific plan. Most Delta Dental plans provide prorated benefits for the remaining treatment. For example, if you’re halfway through treatment when your coverage begins, you might receive 50% of the remaining 50% of your treatment cost.
Can I use both my Delta Dental PPO and my HSA/FSA for braces?
Absolutely! This is one of my top recommendations for patients in our Hollywood location. You can use your Delta Dental coverage for the covered portion and your HSA/FSA funds for the remaining amount, effectively using entirely pre-tax dollars for your treatment.
Does Delta Dental have preferred providers for orthodontics?
Yes, using a Delta Dental PPO network provider (like our practice) typically results in higher coverage percentages and lower out-of-pocket costs compared to out-of-network providers.
Making the Right Choice for Your Smile and Budget
Navigating Delta Dental PPO coverage for braces doesn’t have to be complicated.
At our practice serving the entire Los Angeles area, from Culver City to Pasadena, we’re committed to helping you maximize your insurance benefits while finding solutions for any remaining costs.
Whether you’re dealing with crowding, spacing, bite issues, or other orthodontic concerns, we offer same-day consultations to help you understand exactly what your Delta Dental PPO will cover.
Does Delta Dental PPO cover braces? Yes—with limitations that vary by plan. But with the right dental partner, those limitations won’t stand between you and the smile you deserve.
Book your consultation today: https://ladentalexperts.setmore.com
Sources:
- American Dental Association Insurance Statistics Report: https://www.ada.org/resources/research/health-policy-institute/coverage-access-outcomes
- Journal of the American Dental Association, Vol. 152, Issue 4: https://jada.ada.org
- Delta Dental Plans Association Coverage Guidelines: https://www.deltadental.com/us/en/dental-insurance/dental-insurance-basics.html
- American Association of Orthodontists Insurance Guide: https://www.aaoinfo.org/orthodontic-insurance
- WebMD Dental Insurance Overview: https://www.webmd.com/oral-health/insurance-and-payment-options-for-dental-care