Insider Update

Adult orthodontics has become a popular benefit enhancement in recent years. Adults are opting for orthodontic treatments at higher numbers than ever before, and the number seeking treatment is expected to grow in the next decade.

If you have individual or group clients who are interested in adult orthodontic treatment and coverage, they may have some questions. Here are answers to some of the most common questions about adult orthodontics.

Why should groups offer coverage for adult orthodontics?

Braces can help to treat problems that weren’t treated when patients were younger. An adult with an overbite or underbite, crooked teeth or a misaligned jaw may benefit from orthodontic treatment. Left untreated, these issues may contribute to serious conditions such as tooth decay, headaches and earaches, chewing issues and gum disease.

Can members visit any orthodontist? How can they find an orthodontist?

Delta Dental PPO plan members can see any licensed orthodontist, and they’ll usually save the most when they choose a Delta Dental orthodontist. To find one, they can use the Find a Dentist tool. They just need to search for dentists in the Delta Dental PPO network, then refine their results to include providers with orthodontist as their specialty.

DeltaCare® USA plan members must see their chosen DeltaCare USA dentist for care or get a referral to a specialist for their care to be covered by their plan. If they’ve already begun orthodontic treatment outside of the DeltaCare USA network and have been banded, most plans allow them to continue that treatment with the same coverage and copayments as their previous plan. If banding has not yet taken place, the member must visit a DeltaCare USA orthodontist and pay the copayments listed in their DeltaCare USA plan booklet.

Is Invisalign a covered benefit?

Yes. If a member’s plan includes adult orthodontic coverage, “invisible aligners” like Invisalign are covered as a standard benefit. For plans where alternative appliances aren’t covered, Delta Dental usually covers some of the costs of orthodontic treatment, which can help to reduce members’ overall expenses.

What kind of orthodontic coverage is included in Delta Dental plans?

As with costs, coverage varies, but most Delta Dental plans include:

• Pre-orthodontic treatment visit
• Exam and start-up records
• X‑rays
• Orthodontist-recommended tooth extractions
• Comprehensive orthodontic treatment
• Post-treatment records

Plans usually cover one set of post-treatment retainers. For two-phase orthodontic treatment plans, retainers are usually covered after each phase.

Adult orthodontics aren’t commonplace yet, but they don’t have to be confusing! With these questions answered, your clients will be better able to decide if orthodontic treatment is right for them.