Delta Dental Insurance Plans

Company Overview & Coverage Options

A fundamental question for consumers shopping for dental insurance is "Will my dentist take my coverage?" because insurance is only as good as dental professionals who accept it. In other words, how good are a plan's dental benefits if they're rejected by your preferred dentist and oral surgeon and orthodontist?

Delta Dental has the distinction of being the single largest dental insurance provider in the United States with over 80 million people enrolled across the plans offered by Delta Dental entities. The company leverages this scale of enrollees to attract a large number of dentists to their networks. According to the company, 128,000 dentists and over 198,000 office locations accept one or more Delta Dental plans. Insurance acceptance differs by plan type. For example, Delta Dental PPO has a national network of more than 68,000 dentists practicing in over 119,000 locations. In comparison, their DeltaCare USA offering has just 22,000 dentist office locations, about a fifth of the number of PPO network locations.

The Delta Dental parent company, Delta Dental Plans Association, is a not-for-profit organization. It was originally formed in 1966, but its earliest precursor began in Washington State in 1954. The company has proven very stable over the years, enjoying enormous market growth in the decades following its creation. By 2008, total premium revenue was around $15 billion. By the same year, Delta Dental member companies processed over 81 million dental claims, or approximately 1.5 million every week, with an accuracy rate of 99.5 percent. The organization itself is comprised of 39 independent companies such as Delta Dental Insurance Company, Delta Dental of California, Delta Dental of New York, Delta Dental of North Carolina, and the Hawaii Dental Service. Not surprisingly, Delta Dental plans are available in every one of the United States as well as Puerto Rico and some other U.S. territories. The brand's success with consumers has enabled them to contribute significant sums to philanthropic dental care efforts. The member companies of Delta Dental contributed $79 million in 2018 to community programs across the country expanding access to oral care to underserved populations. In total, 11 million people were helped through 1,700 separate programs.

Plan Options

Delta Dental has a broad portfolio of plan options for consumers to consider. The plans differ not just on deductibles and out-of-pocket costs for services but also breadth of features and the maximum amount of dental expenses to be covered during a single plan year. Since plan options differ by state, we will use Delta Dental plans available within a single state to illustrate our point.

A very affordably priced Dental for Everyone Gold PPO has the following out-of-pocket costs in 2022 during the first year of coverage (note - this plan increases its coverage from the first year of enrollment to the third year of continuous enrollment):

Procedure	1st Year of Coverage for In-Network Dental Care
	Plan Coverage After Deductible	Patient Out-of-Pocket Costs
Cleaning (2x Annually)	60 to 100% (coverage percentage increases across 3 years)	40% to 0%
White Filling	50% to 80% (coverage percentage increases across 3 years)	50% to 20%
Crown	0% to 50% (coverage percentage increases across 3 years)	100% to 50%
Root Canals	0% to 50% (coverage percentage increases across 3 years)	100% to 50%
Simple Extractions	0% to 50% (coverage percentage increases across 3 years)	100% to 50%
Orthodontia	Not Covered Service	100%
Annual Maximum Benefit*	$1,000	Expenses (beyond normal cost-sharing) for covered care exceeding $1,000 in the first year of coverage
Waiting Periods	6 months on basic dental services, 12 months on major dental services	N/A
Deductible	$50 per insured person per calendar year	$50 per person per enrollee
* The Annual Maximum Benefit is the highest amount that the insurer will spend on an enrollee's covered dental services within a 12-month period

Our comparison plan is the higher cost Immediate Coverage Plan PPO, which is also from Delta Dental. The Immediate Coverage Plan PPO has the below out-of-pocket costs during the first year of coverage during 2022. As was the case for the Dental for Everyone Gold PPO, the Immediate Coverage Plan PPO increases coverage from the first year of enrollment to the third year of continuous enrollment.

Procedure	1st Year of Coverage for In-Network Dental Care
	Plan Coverage After Deductible	Patient Out-of-Pocket Costs
Cleaning (2x Annually)	100%	0%
White Filling	50%	50%
Crown	25%	75%
Root Canals	25%	75%
Simple Extractions	50%	50%
Orthodontia	12-month waiting period and then in the 2nd year – 50% after deductible and a $1500 Lifetime maximum per eligible dependent child.	50% after deductible and up until the lifetime maximum is reached.
Annual Maximum Benefit*	$3,000	Expenses (beyond normal cost-sharing) for covered care exceeding $3,000 for each enrollee
Waiting Periods	None for preventive, basic, and major dental care. 12 months for orthodontic services	N/A
Deductible	No deductible for preventive, basic, and major dental care. $150 Lifetime Orthodontia Deductible
* The Annual Maximum Benefit is the highest amount that the insurer will spend on an enrollee's covered dental services within a 12-month period.

When comparing the two plans above we observe several differences. Immediate Coverage Plan PPO, while having a higher premium, also has lower out-of-pocket costs than the Dental for Everyone Gold PPO for various dental services (e.g. crowns, root canals). It also has a higher maximum benefit. Lastly, while both plans do not have orthodontic coverage in the first year, the Immediate Coverage Plan PPO does have care for orthodontic services beginning in the second year of continuous enrollment.

Issues to Consider When Shopping

Not all dental benefits are equal. Some are more relevant to your personal oral health circumstances than others. For example, a person with straight teeth will find orthodontic benefits less significant than a person with crooked teeth. Consequently, a consumer considering a Delta Dental plan should evaluate the different options in light of what their needs are as well as what services may be likely. A final consideration concerns dental care that may not be anticipated but still may happen. Oral health events like cracked molar or an impacted wisdom tooth don't always provide the early warnings we would prefer. Given these possibilities, it is important to ask the following types of questions of a dental plan you are considering for purchase:

• How would the plan cover an unexpected event like breaking a tooth and requiring a crown?
• How would the plan address the need for a partial denture?
• What is the highest amount of dental expenses the plan will cover in a year?

* Delta Dental is coverage underwritten by Delta Dental Insurance Company and available to members of Benefits Association Inc, in the Enterprise states. (AL, CA, DC, DE, FL, GA, LA, MS, MT, NV, PA, TX, UT and WV)