Delta Dental is one of the largest dental insurance providers in the United States. Millions of Americans rely on Delta Dental for their oral health needs. If you are missing a tooth, you might be wondering: will Delta Dental help pay for an implant? And how much will it actually cost you out of pocket?
The answer depends on your specific Delta Dental plan. Delta Dental operates through independent regional companies (e.g., Delta Dental of California, Delta Dental of Michigan). Your coverage depends on the policy your employer purchased. This guide breaks down how Delta Dental handles implants and provides realistic cost estimates.
How Much Will Implants Cost At Delta Dental
Understanding Delta Dental Plans
Delta Dental offers different tiers of plans. The most common are:
1. Delta Dental PPO
This is the most popular plan. You can see any dentist, but you save the most by seeing an in-network PPO dentist.
2. Delta Dental Premier
This is a network with pre-negotiated fees. It is broader than PPO but sometimes has slightly higher fees.
3. DeltaCare USA (HMO)
This is a managed care plan. You must select a primary care dentist, and you pay fixed co-pays for procedures.
Does Delta Dental Cover Implants?
Historically, Delta Dental did not cover implants. They were considered “experimental” or “cosmetic.” This has changed in recent years.
Modern Coverage
Today, most Delta Dental PPO and Premier plans offer some level of coverage for implants. However, it is usually classified as a Major Service.
The Waiting Period
Many Delta Dental plans have a 12-month waiting period for Major Services. This means you must have the plan for one year before they will pay for your implant.
The Missing Tooth Clause
Some Delta Dental plans have a “Missing Tooth Clause.” This states that if you lost the tooth before you enrolled in the plan, the implant is not covered. They only cover implants for teeth lost after the policy started. You must check your specific policy for this clause.
The Cost Breakdown with Delta Dental PPO
Let’s assume you have a Delta Dental PPO plan with the following typical benefits:
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Annual Maximum: $1,500.
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Deductible: $50.
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Major Services Coverage: 50%.
The Treatment Plan:
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Consultation: $100.
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Implant Surgery (Fixture): $2,000.
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Abutment: $500.
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Implant Crown: $1,500.
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Total Cost: $4,100.
The Delta Dental Math:
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Deductible: You pay $50.
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Consultation: Usually covered at 80% or 100% (Preventive/Diagnostic). You pay minimal or nothing.
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Implant Surgery:
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Cost: $2,000.
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Delta pays: 50% = $1,000.
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You pay: $1,000.
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Abutment:
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Cost: $500.
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Delta pays: 50% = $250.
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You pay: $250.
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Crown:
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Cost: $1,500.
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Delta pays: 50% = $750.
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You pay: $750.
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Total Delta Pays: $2,000.
**Annual Maximum:** $1,500.
The Catch: Delta will not pay $2,000 because the annual maximum is $1,500. They will pay $1,500. You are responsible for the remaining $500 in addition to your co-insurance.
Final Out-of-Pocket: $4,100 (Total) – $1,500 (Insurance) = $2,600.
The DeltaCare USA (HMO) View
If you have a DeltaCare HMO plan, the pricing is very different. You pay a fixed fee schedule.
HMO Cost Schedule (Example)
| Procedure | Your Copay (Fixed) |
|---|---|
| Consultation | $20 – $40 |
| Implant Placement | $1,200 – $1,800 |
| Abutment | $300 – $500 |
| Crown (Porcelain) | $500 – $800 |
For HMO plans, you do not have to worry about annual maximums in the same way. You just pay the fixed co-pay for each service. This can be cheaper, but you are restricted to an HMO dentist who agrees to these low fees.
The “Least Expensive Alternative Treatment” Clause
This is a major clause in Delta Dental policies that confuses patients.
What It Means
If there are two ways to fix a missing tooth (a bridge or an implant), Delta Dental might only pay for the cheapest option (usually the bridge).
How It Affects You
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A bridge costs $1,500.
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An implant costs $4,000.
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Delta says, “We will pay 50% of the bridge ($750). If you want the implant, you pay the $750 benefit plus the difference in cost ($2,500).”
This ensures Delta’s costs stay low. Always ask if your plan imposes this clause for implants.
How to Get an Accurate Estimate
You should never guess what Delta Dental will pay. You need a Pre-Treatment Estimate.
The Process
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Ask your dentist: Tell them you have Delta Dental and want a pre-treatment estimate.
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Submission: The dental office submits the x-rays and the treatment plan to Delta Dental.
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The Response: Delta Dental sends back an Explanation of Benefits (EOB). It shows exactly what they will pay, what you owe, and how much of your annual maximum will be used.
This takes about 2 weeks but prevents “bill shock” after the surgery.
The Cost by State/Plan
Delta Dental is not a single company. The fees vary by state.
High-Cost States (New York, California)
Expect higher total costs, but the Delta negotiated rate brings the price down. The negotiated rate is the maximum the dentist can charge for being in-network.
Low-Cost States (Midwest, South)
Total costs are lower, so your 50% coinsurance is lower.
Example:
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New York: Implant fixture cost $2,500. Delta allows $2,000. Delta pays $1,000. You pay $1,000.
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Kansas: Implant fixture cost $1,800. Delta allows $1,500. Delta pays $750. You pay $750.
Maximizing Your Delta Benefits
Here are pro tips for getting the most out of your Delta Dental plan:
1. Use the Annual Maximum Wisely
If your maximum is $1,500, and the implant will use it all up, schedule the implant placement in December and the crown in January. This resets the maximum, allowing you to get benefits for both phases!
2. Stay In-Network
Out-of-network dentists can charge their full fee. Delta will only pay based on their “allowed amount,” which is often lower. You pay the difference.
3. Combine with Medical Insurance
If the implant is needed due to an accident or cancer, your medical insurance may pay for the surgical portion. Delta Dental can pay for the crown. Coordination of benefits saves you money.
Conclusion
Delta Dental will likely cover a portion of your dental implant costs, usually around 50% after a waiting period. However, the annual maximum (often $1,500) limits their total payment, leaving the patient with a significant out-of-pocket bill (often $2,000 – $3,000). HMO plans offer fixed fees, while PPO plans require you to navigate deductibles and maximums. Always obtain a Pre-Treatment Estimate and consider timing your treatment to maximize your annual benefits.
Frequently Asked Questions (FAQ)
Does Delta Dental cover the extraction?
Yes. Extractions are typically covered as a “Basic” service at 80% (for PPO plans). You pay the remaining 20% plus your deductible.
Does Delta Dental cover bone grafts for implants?
Sometimes. Bone grafts are often classified as “Major” and are covered at 50%, but subject to the annual maximum. Some plans exclude bone grafts entirely.
Can I use my FSA with Delta Dental?
Yes. You can use a Flexible Spending Account (FSA) to pay for your out-of-pocket costs for the implant (deductibles, coinsurance).
What is the Delta Dental “Premier” network?
Premier is a fee-for-service network with more dentists. PPO networks generally have lower contracted fees than Premier networks, meaning you save more with a PPO dentist.
Is a single tooth implant covered if I have a missing tooth from before?
If your policy has a “Missing Tooth Clause,” it will not be covered. If the tooth was extracted while you were covered by the plan, you are usually eligible.
Additional Resources
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Delta Dental: For checking your specific plan benefits and finding in-network dentists. Visit www.deltadental.com.
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National Association of Dental Plans (NADP): For general information on dental insurance rights. Visit www.nadp.org.
