Manuel Wallace
Dental insurance plans that cover orthodontics vary widely in what they pay, when they start paying, and how much you'll owe out of pocket for braces. Some plans cover only children, others extend to adults, and premiums, deductibles, and waiting periods differ enough that picking the wrong plan can cost you thousands over a lifetime of care.
At a Glance
- Delta Dental's PPO plan offers the highest lifetime orthodontic coverage limit at $1,500, with a $50 deductible.
- Anthem Blue Cross Blue Shield's PPO has no waiting period but caps lifetime orthodontic coverage at $1,000.
- Spirit Dental & Vision has the lowest premiums among PPOs reviewed, though coverage ramps up slowly over three years.
- Delta Dental's HMO plan, DeltaCare USA, skips deductibles and waiting periods but carries high copays.
- Only Delta Dental's PPO and HMO options, along with Anthem's California HMO, cover adult braces.
Comparing Dental Insurance Plans for Orthodontic Coverage
Anyone shopping for dental insurance plans with braces coverage will notice quickly that the details matter more than the sticker price. A plan with a low premium might come with a slow ramp up in coverage, while a pricier plan might pay out more from day one, just not right away because of a waiting period.
| Plan | Type | Lifetime Orthodontia Limit | Deductible | States Available |
|---|---|---|---|---|
| Delta Dental Premium PPO | PPO | $1,500 | $50 | 15 plus D.C. |
| Anthem Essential Choice PPO Incentive | PPO | $1,000 | $150 (lifetime) | 14 states |
| Spirit Core PPO | PPO | $1,200 | $0 ($100 lifetime deductible) | Nationwide except Washington |
| Delta Dental HMO (DeltaCare USA) | HMO | None stated | $0 | 8 states and D.C. |
What Delta Dental's PPO Gets Right
Delta Dental's Premium PPO plan covers half the cost of orthodontic care once you clear a $50 deductible and sit out a waiting period of six or twelve months, depending on your state. The lifetime cap on braces coverage sits at $1,500, the highest figure found among the plans examined. Complaints filed against Delta Dental with state regulators over a three year span were low relative to the company's size, a sign that policyholders are generally satisfied.
The catch is availability. This particular PPO sample plan operates in 15 states plus Washington, D.C., and while Delta Dental sells policies nationwide, braces coverage isn't guaranteed everywhere. Anyone considering it should check what's actually sold where they live. Delta Dental also runs a not for profit network founded in 1966, made up of 39 independent member companies, some dating back to 1954, with more than 112,000 dentists in its PPO network nationwide.
Anthem's No Wait Option for Kids
Anthem's Essential Choice PPO Incentive plan skips the waiting period entirely and pays 50% of a child's orthodontic costs after a $150 lifetime deductible. The tradeoff is a lower ceiling: $1,000 total, or $500 a year. Still, it's the only plan in this comparison offering half coverage with zero wait, which matters if a child needs braces immediately rather than in a year.
The plan also lowers coinsurance the following year for policyholders who keep up with annual preventive visits. Premiums run higher than average among the PPOs reviewed, and adult orthodontia isn't covered under this plan at all. Anthem does sell a separate HMO in California, the Dental Net 3000D, which covers adult braces with no waiting period, charging a $1,895 copay for adults and $1,695 for children, plus $10 per visit.
Anthem belongs to the Blue Cross Blue Shield Association, a group of insurers that began offering medical coverage in 1929. Its PPO dental network includes more than 136,000 providers across roughly half a million locations, and complaint volume with state regulators has tracked roughly in line with its market share. The parent company renamed itself Elevance Health in 2022, though plan names and coverage stayed the same.
Quick Facts
- Spirit's Core PPO has no lifetime deductible ceiling beyond $100 and no waiting period, but children's coverage starts at just 10% in year one.
- Delta Dental's HMO premium in California runs about $9 a month versus $68 for its PPO Premium plan.
- DeltaCare USA copays for braces can reach $2,800 for adults and $2,600 for children in California.
- In Texas, DeltaCare USA policyholders pay 75% of the usual and customary rate for orthodontic services.
- Ameritas, which underwrites Spirit's plans, ranked last in the J.D. Power 2023 U.S. Dental Plan Satisfaction Study.
Where Low Premiums Come With Tradeoffs
Spirit Dental & Vision's Core PPO Plan carries the lowest premiums among the PPOs reviewed, paired with no annual deductible (just a $100 lifetime deductible) and a relatively generous $1,200 lifetime cap on orthodontia. There's no waiting period either. The problem is how slowly coverage builds for children under 19: 10% of orthodontic costs in year one, 25% in year two, and 50% by year three. Buy early enough before braces are needed and the plan pays off. Adults get no orthodontic coverage under Spirit at all.
Spirit relies on Ameritas as its underwriter and shares that company's provider network of more than 130,000 dentists. But Ameritas' customer satisfaction numbers are weak: last place in the J.D. Power 2023 study, and more regulatory complaints than its market share would predict.
Choosing Between a PPO and an HMO for Dental Insurance Plans
Delta Dental's HMO product, DeltaCare USA, flips the usual tradeoffs. Premiums drop sharply (around $9 a month in California compared to $68 for the PPO), and there's no deductible, no annual coverage limit, and no waiting period. Adult braces are covered too. But the network shrinks considerably since out of network providers aren't reimbursed at all, and copays for orthodontic care run high: up to $2,800 for adults and $2,600 for children in California, or 75% of the usual rate in Texas.
DeltaCare USA is sold in just eight states (California, Florida, Maryland, Nevada, New York, Pennsylvania, Texas, and Utah) plus the District of Columbia, though that's a wider footprint than most competing HMO orthodontic plans offer. Complaint rates against Delta Dental have stayed low relative to its size across all its plan types, PPO and HMO alike, which suggests the company keeps most policyholders reasonably satisfied even as the specific coverage terms vary sharply by plan and by state.
Frequently Asked Questions
What dental insurance plan?
The right plan depends on whether you need coverage for routine cleanings only or for costlier procedures like orthodontics, and whether you want a PPO with a wider network or an HMO with lower premiums and a smaller network.
Is dental insurance with it?
Dental insurance is generally worth it for people who expect to need more than basic cleanings, since even modest coverage can offset costs for fillings, crowns, or orthodontic care that would otherwise come entirely out of pocket.
What is dental insurance for?
Dental insurance helps pay for preventive care like checkups and cleanings as well as more involved treatments such as fillings, extractions, and orthodontics, reducing what policyholders pay directly for dental work.
Why is dental insurance important?
It matters because dental care can get expensive quickly, especially for procedures like braces, and insurance spreads that cost out through premiums rather than leaving a large bill due all at once.
Is dental insurance free for kids?
Not automatically. Under the Affordable Care Act, health plans sold on the Health Insurance Marketplace must include child dental coverage, including medically necessary orthodontia, but this comes through a marketplace health plan rather than being free on its own, and coverage details should be checked during open enrollment.
