Most commonly, delta dental will cover Invisalign at 50% which should result in a 50% copayment for you. However, due to the lifetime maximum orthodontic benefit, it will most likely cover less than half of the effective cost.
The overall cost for Invisalign with delta dental will depend on a couple of major factors:
- Amount of insurance coverage such as the percentage.
- Lifetime maximum orthodontic benefit amount.
- Deductible for the year.
- Length of treatment.
- Orthodontic age limit.
Let us explain what all of that means and how they factor into the overall cost.
Delta dental invisalign coverage
The delta dental coverage for invisalign is usually 50% and that is based on what we see with our patients. That 50 percent figure is based on the hundreds of delta dental insurance plans that we have on record in our clinical practice.
Ultimately how that affects you is that you should be responsible for the 50% that is not covered by delta. That 50% is what is referred to as your copayment for the procedure.
The image above is an example of a coverage breakdown for orthodontic treatment from one of our patients with delta dental. We’ve highlighted in the image showing that orthodontic coverage is 50% with delta.
This is evidence to demonstrate to you what the stated “coverage” is for Invisalign with delta dental insurance.
Exceptions – when the coverage may differ
We wish to emphasize that the most common Invisalign orthodontic coverage is at 50% with delta which means that it can be different. Depending on your particular insurance plan, it could be higher or it could be lower.
We haven’t seen delta dental have a higher coverage than 50% but we have seen it at 0% which is when they don’t have coverage at all.
This just goes to show that the coverage may differ depending on your plan. Usually when you were signing up for the insurance there were probably options for low, basic, and high plans. The different tiers denotes greater or lesser coverage for the different dental procedures.
If your main reason for getting the insurance is to receive orthodontic treatment, you should specifically look at the ortho coverage before selecting the plan.
Lifetime maximum orthodontic benefit amount
Delta dental insurance plans will have varying levels of orthodontic benefit for the year. However, the benefit amount for it is NOT the same as other types of dental procedures. For orthodontic treatment like Invisalign, the benefit amount is a lifetime maximum.
Essentially, the Invisalign benefit you get with delta dental is once per your lifetime. What that means is that the benefit does NOT renew or refresh once the new calendar year comes along. Typically for other procedures like fillings, the benefit will refresh in the new calendar year. That is not the case for Invisalign or any other type of orthodontic treatment.
In the benefits breakdown that we provided above in the previous section, you can see that the patient has an orthodontic lifetime maximum benefit of $1500. We’ve included it below once more so you can see it.
However, there are certain plans from delta dental which have a higher orthodontic benefit limit such as $2000. We’ve attached a benefits breakdown from a different patient below to show you what we mean.
Ultimately, how much benefit you will receive will depend on your specific plan.
How much orthodontic benefit can I get with delta?
On average, we see the lifetime maximum ortho benefit of $1500-$2000 with delta dental. That is the most common amount which we’ve seen.
However, we’ve also seen it as high as $3000 which is quite generous in our opinion. If your plan has that, then that’s great news for you.
Delta dental invisalign cost
The average cost of Invisalign is $6385.28 without insurance but it can cost less with insurance. If you have delta dental, the average cost of Invisalign can be $4385.28 but let us explain how we arrived at that number.
High cost despite 50% orthodontic coverage
Despite the benefits summary saying that there is 50% orthodontic coverage which includes Invisalign, it won’t actually cover 50% of the treatment. The reason is because the limiting factor in the treatment cost is the orthodontic maximum benefit.
Example with calculations:
- Delta’s 50% coverage of Invisalign’s $6385.28 is $3192.64
- However, if your maximum orthodontic benefit is only $2000, your insurance will only cover $2000 out of the $3192.64
- Essentially that leaves you with an additional $1192.64 ($3192.64 – $2000).
- Therefore your total is $3192.64 + $1192.64 = $4385.28
That is how we arrived at that number and it also explains why you may end up paying for more than half of the procedure out of pocket despite having 50% coverage.
Annual deductible
Most dental insurances have an annual deductible which must be paid prior to benefits being disbursed. In other words, the deductible needs to be paid first or met before the insurance will start covering services and that includes orthodontic work.
The most common deductible which we see from our delta dental patients is about $50 in total. However we’ve also seen it as low as $25 and as high as $100.
The amount varies and depends on your specific insurance plan which you signed up for. Basically if you have a deductible, it will be an additional cost to your clear aligner treatment.
Length of treatment
How long the Invisalign treatment will take will definitely affect the overall cost. For severe malocclusion and lengthy cases, there may be an additional fee on top of what we discussed.
An example would be if your case takes 3-4 years to finish straightening your teeth vs only 1-2 years. Of course the longer treatment would cost more than the shorter one.
Orthodontic age limit
Last but not least you need to be wary of whether or not there is an orthodontic age limitation with your delta dental plan. If there is such a stipulation, even if you have “coverage” you may be denied benefits if you exceed the age limitation.
How to decrease the cost of Invisalign
There isn’t a way to make the invisalign treatment cost less with delta dental unless you purchase a plan with a high orthodontic benefit. Although for that you may need to wait for the next enrollment period to switch to a different plan.
Aside from that you could also try moving to a lower cost of living state or neighborhood. Typically the fees are relative to the cost of living in your area. Basically, you can expect it to cost more in New York vs Kansas.
Takeaway
Most of the delta dental PPO plans will cover Invisalign at about 50% but due to the maximum orthodontic benefit, it’ll end up less than that. The best way to get an accurate quote is by having your dentist send out a pre-determination to see how much your insurance would pay. That way you know for certain what you’d be responsible for.