After a long wait, Covered CA is now offering individual and family dental coverage for 2016. Plans available include both dental HMO and PPO plans through these carriers: Access Dental, Anthem Blue Cross, Delta Dental of California, Dental Health Services, and Premier Access. Both adults and children may enroll (Note: Pediatric dental is embedded in all health plans, so enrolling a child in a dental plan offered would be supplemental). We can arrange for you to enroll when we renew your Covered CA health plan for next year–but we must know by December 15 if you want this coverage.
Important Things to Know About Covered CA Dental Plans
Purchase Requirements: Dental plans are only available to those already subscribed to health plans through Covered CA. There must be one adult (19 or older) enrolled in a dental plan in order to enroll a child (under 19) for dental coverage. All adults in a household are not required to enroll, but if children are being enrolled, all children in the household must sign up. (Note: Pediatric dental is embedded in all health plans, so these dental plans are supplemental. See below for more information about enrolling children).
Plan Basics: Preventive and diagnostic services are provided at no cost. This includes cleaning and X-rays. Basic (i.e. fillings) and major (i.e. root canals) procedures are covered, but there may be an annual maximum amount that a plan will provide. Likewise, some plans may require waiting periods before certain procedures will be covered (from 6 to 12 months). There is no out-of-pocket limit for adults.
Two Plan Types: There are two types of dental plans offered:
Dental HMO:There is no annual deductible on HMO plans and no maximum limit on what the plan will cover. Instead, HMO plans charge a set negotiated fee or co-pay for the services performed. Dentists must be in-network — no out-of network coverage is allowed. Premiums are lower for dental HMOs than for dental PPO plans. See the Covered CA Family Dental Rate Booklet for a listing of sample HMO rates you would pay for different procedures.
Dental PPO: Unlike dental HMOs, PPO plans share the costs of dental procedures between the consumer and the insurance company at a fixed percentage. This is usually between 20 and 50 percent, depending upon the procedure. There is also an annual deductible of $50 per adult. Dental PPOs have a much broader network of providers and most will allow some coverage out-of-network, as well. They do generally require wait periods for certain types of procedures of between 6 and 12 months. See the Covered CA Family Dental Rate Booklet for information on typical rates under PPO plans.
Enrolling Children: Pediatric dental is embedded in all medical plans, so the dental plans offered are supplemental and may offer a wider choice of providers than the medical plan. When children are covered by both the plan embedded with their medical coverage and a supplemental Covered CA dental plan, their benefits are coordinated between the two plans. There is an annual $350 out-of-pocket maximum per child or $700 maximum if more than one child is enrolled.
No Financial Assistance is Available: Unlike Covered CA’s medical plans, no financial assistance is available to help pay monthly premiums for dental plans. If you enroll, you will be responsible for paying the entire monthly premium due.
What To Do Prior to Enrolling in a Dental Plan
Review the Covered CA Family Dental Rate Booklet. This will explain the different plans available and what you can expect to pay based upon where you reside. It will also explain the benefits for each plan offered.
If you already have a dentist, call their office and check to see if the plan you like is accepted.
If you do not have a dentist, then you will be able to choose one who is contracted with whichever carrier you elect via their provider network.
Read “Other Things to Know About Covered CA Dental Plans” below to be sure you understand the ins and outs of dental coverage and benefits.
Once you have chosen a plan, call us and we will enroll you as part of your 2016 Covered CA renewal.