Delta dental may have an orthodontic coverage age limit but it depends on your specific insurance plan.
When you signed up for the insurance, you were most likely offered various tiers of the plan such as low, basic, and high plans. Each one of them will have different coverage, limitations, and stipulations. All of these exceptions will have a small footnote followed by fine print explaining what they are.
Hopefully you’ve read the fine print closely. Nonetheless, we’ll still go over what some of the common exceptions with orthodontic age limits that we see with our delta dental patients.
Orthodontic age limitations with delta dental
The two most common age limits that we see with delta dental orthodontic coverage are age 19 and 26. That means if you are below either of those ages, you will not have any coverage for the procedure at all. In other words you will be responsible for the full cost of treatment.
The image above is an example of procedure limitations from delta dental with one of our patients. As you can see, the coverage breakdown does have a separate column called “Age Restrictions” for various treatments.
It’s not just orthodontic treatment that may have age limitations because other procedures can as well. The age restriction can be any age that your plan states but the most common that we’ve seen from delta are 19 and 26 years old.
How the age restriction affects orthodontic coverage
If your delta dental plan has an age restriction and you’re above the age limit, it would mean that you have no orthodontic coverage. Essentially, you’ll be responsible for paying the entire treatment out of pocket with no help from your insurance.
But insurance breakdown says there is 50% orthodontic coverage!
Often times, patients will sign up for a delta dental plan that says 50% orthodontic coverage and they’ll think that they have coverage. Little do they know that there is a little footnote next to that coverage percent which you must read.
If your insurance says you have 50% orthodontic coverage but there is an age limit of 19. You will not have any coverage at all since you’ve exceeded the age limit. The exception or footnote takes precedence over what the coverage says.
Basically what you need to do is read the delta dental insurance contract carefully. If you see a footnote, asterisk, or any type of note next to a procedure, you should read it!
Other orthodontic coverage stipulations
Aside from the age restriction, we’ve also seen delta dental with an additional exception that restricts coverage to dependents. Instead of saying below a certain age will qualify, the ortho benefits are only valid for dependents. That means if you’re not the subscriber’s child or dependent, you will not have any ortho benefits.
What all of this means for you
If you are signing up for a delta dental insurance plan you should read the contract carefully if you plan on having orthodontic treatment (braces or invisalign).
There are three things that you should look out for:
- Is there orthodontic coverage?
- Is there an age limitation?
- Is it only valid for dependents?
Make sure there is no language in the contract that would disqualify you from orthodontic treatment benefits.
Is there orthodontic coverage?
If you want ortho benefits, make sure the coverage percentage for orthodontics is greater than zero. The most common coverage percentage which we see with our delta patients is 50% but it may be different depending on your plan. However we’ve never seen it at 100% so don’t dream of it!
Is there an age limitation?
You should call delta and inquire about your plan to see if there is an age restriction for orthodontics. If you’re below the age limit, you’ll be excluded from benefits even if it says 100% orthodontic coverage!
Is it only valid for dependents?
Last but not least, you should double check to see if there is language which states that the procedure benefits are only valid for dependents. If you’re a dependent then it is not an issue but if you’re the subscriber, you may not have coverage.
Takeaway
Insurance with delta dental may have orthodontic coverage age restrictions but it depends on the plan that you signed up for. This is why it is important to ask the right questions before you sign the contract. Exclusionary language may void your coverage.