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Every common question about Medicaid braces in Delaware in one place - eligibility, HLD Index, plans accepted, the pre-authorization process, what's covered, what isn't, what to do if you're denied, and what to expect at the free evaluation. Honest answers, no hype, no hidden fees.
Yes. Delaware Medicaid (the Diamond State Health Plan and the Delaware Healthy Children Program) covers medically necessary orthodontic treatment for children and teens under 21. Coverage requires a qualifying score on the HLD Index (typically 26+) or one of several auto-qualifying conditions, plus pre-authorization from the patient's managed-care plan.
All three Delaware Medicaid managed-care plans: Highmark Health Options, AmeriHealth Caritas Delaware, and Delaware First Health. Plus the Delaware Healthy Children Program (CHIP). In-network at all four offices.
Schedule a free Medicaid evaluation at any Stellar office. Our orthodontist completes a full exam, scores the HLD Index, and checks for auto-qualifying conditions. You learn whether your child qualifies before leaving the office. See our full eligibility guide for the HLD Index walkthrough.
The Handicapping Labio-Lingual Deviations Index is a standardized scoring system Delaware Medicaid uses to determine medical necessity. Measurements such as overjet, overbite, anterior crowding, crossbites, open bite, and missing teeth are scored and added. A total of 26 or higher generally qualifies.
Auto-qualifying conditions include cleft lip and palate, impacted maxillary anterior teeth, severe deep overbite with palatal impingement, severe traumatic deviations from accident or injury, severe crossbite with functional impact, and certain documented developmental craniofacial conditions. These qualify regardless of HLD point total.
Adult orthodontic coverage under Delaware Medicaid is very limited and exception-based. Most adults over 21 are not eligible for the routine orthodontic benefit. Call (844) 727-2237 to discuss your situation honestly - we'll explain whether you qualify and what financing looks like if you don't.
Yes, as long as they are under 21 and enrolled in DSHP or CHIP. The EPSDT benefit runs through age 20. If your teen is 19 or 20, call promptly so we can plan a treatment timeline that fits inside the coverage window.
Generally no. Delaware Medicaid covers traditional fixed metal braces for medically necessary cases. Invisalign and clear aligners are an upgrade option that requires private payment, with monthly financing available.
Generally no. The covered modality is traditional fixed metal braces. Clear ceramic braces are an upgrade and the difference is private-pay. Many families upgrade only the upper arch to lower the total upgrade fee.
Complete diagnostic records, traditional fixed metal braces, all scheduled adjustment visits, repairs to broken brackets or wires during treatment, removal of appliances at the end of treatment, and the initial set of retainers. Phase 1 (early) appliances when medically necessary.
The initial set at the end of active treatment is covered. Replacements (lost, broken, or warped later) are private-pay at a transparent flat rate. See our full cost breakdown.
Typically 2 to 4 weeks once Stellar submits the complete records package to your managed-care plan electronically. Clear-cut cases sometimes return in 7 to 10 business days. Borderline cases may take 3 to 4 weeks. We notify you the same day we receive the decision. See our full process guide.
Diagnostic photos, a panoramic x-ray, a cephalometric x-ray, a 3D iTero digital scan, the completed HLD Index form, and a clinical narrative. Stellar assembles and submits everything electronically - you don't touch any of it.
Stellar reviews the denial reason and walks you through the options: written appeal with additional documentation, peer-to-peer review between the Stellar orthodontist and the plan's dental consultant, a Delaware Medicaid fair hearing through DMAP, or a private-pay plan with monthly financing. We never start treatment without your explicit consent and a clear cost understanding.
Often no. Most Delaware Medicaid plans allow self-referral for orthodontic evaluation. Some plans appreciate (but do not require) a referral letter. Stellar can confirm your specific plan's requirements when you call.
Yes. Stellar accepts Medicaid transfer cases. Bring your previous records and we will coordinate continuation of treatment with your managed-care plan.
Call us immediately. Stellar walks you through the options - recertifying coverage, transferring to a private-pay plan with monthly financing, or adjusting the appointment cadence while you resolve coverage. Cases already authorized are typically grandfathered to completion. We will not abandon a patient in active treatment.
For qualified patients under 21 with pre-authorization approved, the covered services have no member cost-share. The free Medicaid evaluation is free regardless of qualification.
If denied and you choose private-pay, traditional metal braces in Delaware typically run $3,000 to $6,500. Clear ceramic braces $4,000 to $7,500. Invisalign $3,500 to $7,500. Stellar offers monthly payment plans, HSA/FSA payments, and sibling discounts.
If your child qualifies and pre-auth is approved, no member cost-share for the covered services. Upgrades to Invisalign or clear ceramic braces, and replacement retainers after the initial set, are private-pay. Full cost breakdown.
Medicaid does not partially fund upgrades, so the full Invisalign fee is private-pay. Invisalign in Delaware typically runs $3,500 to $7,500 depending on case complexity. Monthly financing available.
Monthly payment plans, most major dental insurance accepted, HSA and FSA payments, sibling and multi-patient discounts, and a transparent written estimate at the free consultation. See our Financing & Insurance page.
We have four Delaware Medicaid locations: North Wilmington (Concord Pike), Middletown (Kohl Ave), West Dover (Greentree Dr), and Millsboro (Centerview Dr). All four accept Medicaid.
Your child's Medicaid member ID card, your child's date of birth, photo ID for the parent or guardian, and any prior dental or orthodontic records (helpful but not required). Don't bring payment - the evaluation is free regardless of qualification.
Every 6 to 8 weeks for adjustment visits. About 30 minutes each. Same orthodontist every appointment. Active treatment averages 18 to 24 months for pediatric cases.
Yes. We fit a custom orthodontic mouthguard for any Stellar braces patient in contact sports. The mouthguard protects the teeth and the appliances. Wind instruments, dance, cheer, and theater all work fine with braces.