Does Delta Dental PPO Cover Night Guards Cost?

Among the many protective measures in dental care, night guards stand out, especially for those with conditions like bruxism. A commonly asked question is whether insurance plans, like Delta Dental PPO, cover these protective devices. This article will shed light on that query based on comprehensive research.

Is Night Guard Covered by Delta Dental PPO?

Yes, night guards are typically covered by dental insurance if they are deemed medically necessary by your dentist. The actual coverage extent, however, hinges on the specifics of your insurance plan. Some plans may cover the entire cost, while others may only cover a portion, leaving the remainder for the patient to handle.

How Much Does Delta Dental Cover?

Research indicates that on average, Delta Dental covers 80% of the night guard cost. Here’s a breakdown based on coverage levels:

  • 80% Coverage: Most patients with Delta Dental are observed to have this level of coverage. This means that Delta will foot 80% of the bill, leaving only 20% for the patient.
  • 100% Coverage: Some fortunate patients with high-tier plans might get complete coverage, resulting in zero out-of-pocket expenses.
  • 50% Coverage: On the lower end, some plans might cover only half the cost of the night guard.

What Costs are Involved in Getting a Dental Night Guard?

Expense CategoryDescription
Dental ExamBefore obtaining a night guard, a dental exam determines the severity of your bruxism. Insurance may necessitate this examination to verify the medical need for a guard.
Out-of-Pocket CostsDepending on your insurance coverage, you might need to cover a portion of the night guard’s cost.
Replacement CostsNight guards, over time, might need replacement due to wear and tear. Insurance might only cover replacements after a set period, typically years.
Varying Costs Based on SourceBuying from your dentist might range between $300 to $1,000, depending on insurance. Online custom retailers range from $50 to $200, while over-the-counter options at regular retailers are around $20 to $30.

Frequency Limitation

While you might have coverage for a night guard, Delta Dental can impose a frequency limitation. For instance, some insurance plans might not approve a new night guard claim if you got one recently. Based on observations, Delta Dental often has a 5-year frequency limitation for night guards. If you have switched insurance providers, these limitations might not apply unless your previous provider was also Delta Dental.

Frequently Asked Questions

1. How often can I get a new night guard with Delta Dental PPO?

Delta Dental typically has a 5-year frequency limitation for night guards. This means if you’ve had a night guard approved in the last 5 years, they might not cover a new one until this period is over.

2. Are there additional costs associated with getting a night guard?

Yes, aside from the guard itself, you might have costs related to dental exams, out-of-pocket expenses based on your coverage, and potential replacement costs if your night guard wears out or breaks.

Conclusion

Night guards play a crucial role in dental care, especially for those with conditions like bruxism. While Delta Dental PPO offers varying degrees of coverage for these devices, it’s paramount to understand your plan’s specifics. From the percentage of coverage to frequency limitations, and out-of-pocket costs, being informed can save you from unexpected expenses and ensure that you get the best possible care for your dental needs.

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