Billing · Updated 2026-09-08 · 5 min read
What is Delta Dental PPO MAC?
A MAC plan pays the PPO fee schedule to every tier, including Premier and non-participating dentists — and Delta's own product sheet says the patient owes the gap.
Delta Dental PPO MAC is a Delta Dental PPO plan that pays the PPO discounted fee schedule to every provider tier — PPO, Premier and non-participating alike. For a Premier office that means being paid the PPO number on a patient you are contracted with, and one Delta company's product sheet states that the member is responsible for the difference between the Premier allowance and the PPO fee. That is the counter-intuitive part: on a MAC plan a contracted Delta dentist can legitimately balance-bill a contracted Delta patient. It is not a processing error and it is not a contract breach. The employer bought the design. Kaylie has not measured how often a Delta plan is a MAC plan; the carrier's stated policy is below.
What Delta Dental's own documents say
A benefit summary states the rule as a footnote a patient could in principle read:
"Members will be subject to billing for the difference between the PPO Approved Fee and the Participating Dentist Maximum Approved Charge (PMAC). Coverage percent is based on the PPO Schedule of Fees."
— Delta Dental NJ/CT PPO-3-A Benefit Summary, 2020 template vintage. The same footnote appears on the PPO-4-A and PPO Voluntary templates in that family.
And a product sheet spells out what happens to each tier on the same plan:
"If the network for your dental plan selection is MAC PPO: Payment for a PPO dentist is based on the PPO dentist's allowable fee or the submitted fee charges, whichever is less… Payment for a Premier dentist is based on the PPO dentist's allowable fee. Members are responsible for the difference between the Premier Maximum Reimbursable Amount (MRA) and the PPO fee."
The same sheet, on the third tier:
"Payment for a non-participating dentist is based on the PPO dentist's allowable fee. Members are responsible for the difference between the PPO Allowance and the full submitted fee charged by the dentist."
— Delta Dental of Arizona Flex Choice Group Plan Benefit Highlight Sheet, form DDAZ-0532-rev0825, 2025. The Premier ceiling is named differently by each Delta company: maximum plan allowance (MPA) in Delta's own broker material, Maximum Reimbursable Amount (MRA) on the Arizona sheet, Participating Dentist Maximum Approved Charge (PMAC) on the New Jersey and Connecticut templates. One ceiling, three names.
Note what the non-participating rule does to an out-of-network estimate. The plan's out-of-network allowance is not a percentile of area charges and it is not a separate non-participating table. It is the PPO fee schedule — the same number a PPO dentist would be paid.
The word "balance billing" is used two ways inside the same carrier family, and a biller who does not notice will reach the wrong conclusion. Delta's own definition turns on the patient's cost share:
"balance billing, which occurs when a patient is charged more than their defined cost share for covered services"
— Delta Dental, "Protect your patients beyond the chair: Avoid balance billing issues", FYI, April 23 2026. Charging above the cost share the plan defines is the violation. The MAC gap is not that: on a MAC plan the difference between the PPO fee and the Premier allowance is the cost share the plan defines, written into the design the employer bought. If you are checking a policy, read which of the two meanings the document is using.
Why it depends on the plan
MAC is a plan attribute, not a network. Nothing about your contract changes when a MAC patient sits in your chair; what changes is the allowance the plan will pay from. Delta puts the choice to the employer in plain terms: under a PPO plan, Premier dentists are reimbursed at either Premier or PPO fees, and "How Premier dentists are reimbursed under your PPO plan is up to you" — Delta Dental, "PPO and Premier: How Delta Dental's dual network works", Word of Mouth, October 14 2022.
MAC is also sold as the cheap end of a product ladder. On the Arizona Flex Choice sheet, three of the four options are MAC PPO with annual maximums of $500, $1,000 and $1,500, and only the $2,500 option is PPO plus Premier. An employer that chose MAC chose a lower premium, and the lower allowance travels with it to your patient.
The label varies by state company. One Delta writes it out as "Delta Dental PPO with Maximum Allowable Charge"; others abbreviate it "Delta Dental (PPO MAC)"; a benefit summary prints "PPO Fee (MAC Plan)" in the out-of-network reimbursement row. And "PPO MAC" is not a Delta-only term: Guardian sells a product named DentalGuard Preferred PPO MAC, and at Ameritas "PPO MAC fees" simply means the contracted office's own fee schedule. The acronym does not carry a fixed meaning across carriers, so read the plan rather than the three letters.
What to do
- Establish before treatment whether the plan is MAC. If it is, your estimate runs off the PPO schedule regardless of which network you are in.
- Load the Premier maximum plan allowance as well as the PPO schedule. On a MAC plan you need the PPO fee to predict the payment and the Premier allowance to know the ceiling on what you may bill the patient.
- Bill the patient no more than the gap between the PPO fee and the Premier allowance. Under the agreements quoted here, and subject to your state's law, above the Premier allowance there is no contractual right to bill; that is the write-off.
- Say it to the patient in advance and in writing. The balance is a feature of their plan, and a patient told after the fact reads it as a billing error.
- Do not treat a MAC patient's remittance as evidence of your Premier allowance. It is the PPO number, and filing it as "what Delta allows" corrupts every later estimate.
- Where the plan is not MAC, ask which allowance applies to a Premier dentist. That answer, not the coverage percentage, is what decides the patient's bill.
Numbers last refreshed August 2026.