Does Delta Dental PPO Cover Night Guards?
Do you know if Delta Dental PPO covers night guards and what the coverage limitations are? We’ve got you covered! Night guards are essential for people who grind their teeth, as they help prevent serious dental issues like cracked teeth, jaw pain, and tooth sensitivity. In this article, we’ll explore Delta Dental PPO’s coverage for night guards and what you need to know before getting one.
Delta Dental PPO Night Guard Coverage
Yes, Delta Dental PPO covers night guards, but coverage varies by plan. Typically, Delta Dental PPO plans cover custom-made night guards, which are specifically tailored to your mouth by a dental professional. This ensures a more comfortable and effective fit compared to over-the-counter options. However, it’s always recommended to check your plan’s details or consult with your dentist for a pre-treatment estimate to understand your out-of-pocket costs and coverage limitations.
DeltaCare USA Night Guard Coverage
DeltaCare USA also offers night guard coverage with copayments. While the DeltaCare USA plan typically has lower out-of-pocket costs compared to PPO plans, it offers coverage for a range of dental procedures, including night guards, routine cleanings, and more. The convenience of these plans lies in their predictable copayments and easy-to-use benefits system.
How Much Does a Night Guard Cost with Delta Dental?
The average cost of a custom night guard with Delta Dental PPO is around $100 with 80% coverage. In most cases, Delta Dental PPO will cover 80% of the cost of a custom-made night guard, leaving an estimated copay of about $100. However, your actual cost will depend on the specific plan details and any copayment variations.
Factors Affecting Cost:
- Deductibles: Most Delta Dental plans have an annual deductible of around $50, which needs to be met before the insurance covers the night guard.
- Annual Maximum Benefit: Night guards may use up a portion of your annual maximum benefit. If you’ve already used most of your benefits for other treatments, your out-of-pocket cost may be higher.
- Frequency Limitations: Delta Dental usually limits night guard coverage to one every 5 years. This means if you need a replacement sooner, it may not be covered.
Types of Night Guards Covered by Delta Dental
There are three main types of night guards:
- Soft Night Guards: Recommended for light to moderate teeth grinding.
- Dual Laminate Night Guards: Made of a soft inner layer and a harder outer layer for moderate to heavy grinding.
- Hard Night Guards: Best for severe grinding and clenching, but may be less comfortable initially.
Delta Dental generally covers custom-made night guards, which are created using an impression of your mouth for a precise fit. They may not cover over-the-counter options.
Pros and Cons of Each Night Guard Type
| Type of Night Guard | Pros | Cons |
|---|---|---|
| Soft Night Guard | ComfortableEasy to adjustLess expensive | Less durableMay not be effective for severe grinding |
| Dual Laminate Night Guard | More durableProvides a balance of comfort and protection | More expensiveHarder to adjust to |
| Hard Night Guard | Very durableBest protection for severe grinding | Uncomfortable at firstMost expensive |
FAQs
1. Does Delta Dental cover over-the-counter night guards?
No, Delta Dental PPO usually does not cover over-the-counter night guards. Custom night guards prescribed by a dentist are typically the only option covered under most plans.
2. How do I know if I need a night guard?
If you experience symptoms like tooth sensitivity, jaw pain, or a clicking jaw, you may need a night guard. Talk to your dentist for a thorough evaluation.
3. Does Delta Dental require pre-authorization for night guards?
In most cases, Delta Dental does not require pre-authorization for night guards, but it’s always a good idea to get a pre-treatment estimate to understand coverage and costs beforehand.
