Delta Dental plans: PPO, Premier

Delta Dental is not one insurer. Delta Dental Plans Association is the national association of independent Delta Dental companies, and each company administers plans in its own territory. So two people who both say they have Delta Dental can hold very different coverage. The brand sells five plan types: PPO, Premier, PPO Plus Premier, DeltaCare USA (a dental HMO) and Patient Direct (a discount plan). Network dentists agree to a Delta Dental fee schedule and may not bill above it for covered services. Most plans also let you see a dentist outside the network, with higher costs likely. What you actually pay still depends on your plan document: the annual maximum, the deductible, waiting periods and any downgrade provision. Ask the dental office for its procedure codes, then ask Delta Dental which tier each code falls in and whether a downgrade provision applies to any of them.

Before you book: verify delta dental plans

1
Read your ID card or member account to find which Delta Dental company administers the plan
2
Ask which networks the plan includes, then ask the dentist which of them the office joined
3
Request the annual maximum, deductible and remaining balance in writing
4
Ask whether the treatment needs preauthorization or has a waiting period
5
Request a pretreatment estimate before major work

Five plan types

What each Delta Dental plan is

Factor	Detail
Delta Dental PPO	The preferred-provider plan. Dentists in the PPO network accept reduced fees for covered services. Delta Dental's plan chart lists an annual maximum, a deductible and copayments.
Delta Dental Premier	The original fee-for-service plan, described by the company as its largest network. Contracted dentists cannot bill above the agreed fee for covered services. The chart shows an annual maximum, a deductible and copayments.
PPO Plus Premier	Combines the PPO and Premier networks. A Premier dentist who is outside the PPO network still gives you the benefit of that dentist's contracted fee.
DeltaCare USA	A dental HMO. You choose a primary care dentist from the DeltaCare network, and that dentist manages referrals to specialists. The chart shows no annual maximum and no deductible, with copayments.
Patient Direct	A dental service discount plan. You pick a participating dentist, pay the discounted fee at the visit and file no forms. The chart shows no annual maximum and no deductible.

Plans and rates vary by state, and availability differs. The company you can buy from depends on where you live or where your employer is based.

Network status

What changes when the dentist is in your network

Factor	Detail
Fees	Network dentists have agreed to accept reduced fees, so out-of-pocket costs run lower than with an out-of-network dentist.
Balance billing	Network dentists accept Delta Dental's fee plus your copayment or deductible as full payment. The exception: once you reach the annual dollar maximum or a frequency limit, you owe the charges.
Claims	The dentist submits the claim and Delta Dental pays the dentist directly. You wait for no reimbursement check.
Credentials	Delta Dental says its network dentists meet national credentialing standards.
Specialists	With most plans you can see a specialist with no prior approval. Some plans require preauthorization, so check yours.
Out-of-network care	Most plans let you visit any dentist. Some pay benefits only for network dentists. DeltaCare, Medicare Advantage and certain exclusive PPO plans fall in that group.
Travel within the country	Networks are nationwide. Most plans give the same benefits anywhere in the 50 states, Washington, D.C. and Puerto Rico.
Treatment abroad	Some Delta Dental products cover care received outside the U.S. Ask your administrator whether yours does.

Finding the right office

Which Delta Dental do you call?

Look at the ID card or the member account to see which Delta Dental company administers your plan
Group members usually deal with the company in the state where the employer is headquartered
Individual members deal with the company that serves the state where they live
Sign in to see the plan type, the covered services, the deductible met and the annual maximum remaining
Search for dentists by network, since the search needs to know which network your plan includes
If you change jobs or your employer moves to a different Delta Dental company, expect to create a new online account

The published estimator

How to read Delta Dental's cost estimator

Delta Dental publishes a Dental Care Cost Estimator. Its own terms call the figures estimates and say they are no guarantee of payment or benefits. For most users the tool shows estimated dentist charges and not what the plan would pay. The exceptions the page names are members of Delta Dental of New Jersey, Connecticut and Idaho, who see an estimate of out-of-pocket cost. The figures labelled cost without insurance come from claims that out-of-network dentists submitted, at their actual, non-discounted charges. Estimates are built from the first three digits of a ZIP code. The tool covers the 50 states, Washington, D.C. and Puerto Rico and offers no content for dental services outside the U.S.

Delta Dental also tells users not to avoid care because of a cost figure.

Treat any estimator figure as a prompt to request a written pretreatment estimate from your administering Delta Dental company.

Where people get caught

Common surprises with Delta Dental coverage

Hearing that a dentist takes Delta Dental and assuming that means your network. Ask which network the office joined.

Reaching the annual maximum or a frequency limit. Network protections against billing extra stop there.

Waiting periods. Delta Dental says preventive services are generally covered from day one, while fillings, crowns or bridges may carry a wait depending on the plan.

Cosmetic treatment such as teeth whitening. Employer plans usually exclude it, and Delta Dental describes coverage as rarely provided by any dental insurance.

Paying up front. A dentist outside your plan's network may ask for payment at the visit.

Plans that require the network. DeltaCare, Medicare Advantage and certain exclusive PPO plans pay only for dentists in the named network.

Questions people ask

Common questions

Is Delta Dental one company or many?

Many. Delta Dental Plans Association is the not-for-profit national association of independent Delta Dental companies. Each one administers benefits in its own territory, which is why the company that answers your questions depends on where your employer is headquartered or where you live. The ID card and the member account tell you which one holds your contract. Start there.

What is the difference between Delta Dental PPO and Premier?

Both are network plans where contracted dentists cannot bill above the agreed fee for covered services. PPO dentists accept reduced fees under a preferred-provider arrangement, and Delta Dental's chart pairs that with the lowest out-of-pocket costs. Premier is the original fee-for-service plan and the company describes it as the largest network. Which one you hold decides which dentists give you the best rate.

What does PPO Plus Premier add?

It combines the two networks. Under Delta Dental's description, a Premier dentist who is not in the PPO network still gives you the benefit of that dentist's contracted fee. The plan widens the set of dentists who charge you a negotiated fee, so ask the administering company how the two network rates are applied to your plan.

Do I have to pick a dentist with DeltaCare USA?

Yes. DeltaCare USA is a dental HMO, so you choose a primary care dentist from its network. That dentist manages your care and refers you to specialists, and receives a monthly capitation amount for the patients enrolled. Benefits go only to dentists in the DeltaCare network, so an outside dentist is not an option under this plan.

Can I see a dentist who is not in the Delta Dental network?

With most plans, yes. Delta Dental says most of its plans allow any dentist, and a few pay benefits only for network dentists. The cost is the usual catch. Expect higher out-of-pocket charges out of network, and expect the office to ask for payment at the visit. Check first. Then book.

If a dentist says they take Delta Dental, am I covered at the in-network rate?

Not necessarily. Dentists can join one Delta Dental network and not another, and your plan pays the in-network rate only for the networks it includes. Delta Dental's own advice to dentists is to name the specific network when a patient asks. Ask the office which network it joined, then match that to the networks on your plan.

Can a network dentist bill me for the difference between their fee and Delta Dental's?

For covered services, no. Network dentists accept Delta Dental's fee plus your copayment or deductible as payment in full, and Delta Dental describes balance billing as not allowed. The limit is your benefit ceiling. After you reach the annual dollar maximum or a frequency limit, you are responsible for the charges.

Who do I call about a claim or a benefit question?

The Delta Dental company that administers your plan, and not the national office. The ID card shows which one it is. If you have no card handy, sign in at deltadental.com. Claims go to the company that insures the patient, and dentists are told the same. Group members are usually served by the company in the employer's headquarters state.

Does Delta Dental cover treatment outside the United States?

Some products do. Delta Dental says a few of its plans cover dental care received abroad and tells members to ask their administrator. Its Cost Estimator says it provides no content for services outside the U.S. If you are weighing treatment overseas, get the answer for your specific plan in writing before you go. Do not guess.

What happens if I have Delta Dental and another dental plan?

One plan is treated as primary and pays first. The other plan pays toward whatever remains. Your plan documents contain a coordination of benefits provision that explains the order. Delta Dental states that together the plans cannot pay more than the full cost of the treatment, so a second plan reduces your share without paying you extra.

Do I need approval before seeing a specialist?

With most Delta Dental plans, no. You can see a specialist without prior approval, and the Find a Dentist tool lets you search for oral surgeons, pediatric dentists and orthodontists in the network. Some benefit plans and some providers do require preauthorization or a referral, so confirm before you book. Ask the office.

Does Delta Dental sell dental insurance to individuals?

In most states, yes. The Delta Dental companies offer individual and family plans in most states, and the plan mix differs by state. Delta Dental's site sends you to the local company after you enter your state. Plans, rates and the networks you can use all depend on where you live.