Covered California Dental Plans

While pediatric dental coverage has been included in Covered California health plans, as of January 1st, 2016 you now also have the option to purchase a family dental plan in addition to your medical plan through Covered California. Kids still have pediatric dental coverage embedded into the health plans through Covered California but if you choose to purchase a family dental plan you will likely have more dentists to choose from and more coverage benefits. For covered ca dental carrier information, prices and benefits, please review the Covered California 2016 Dental Plan Booklet

Who Can Enroll in a Family Dental Plan

Any adult enrolled on a health plan through Covered California can enroll in a family dental plan. If you’re married and your spouse needs dental coverage but you don’t, you have the option of enrolling just your spouse in the dental plan of your choice.

Children enrolled on a health plan through Covered California can enroll in an optional family dental plan if one adult from the household enrolls on dental. An adult would be anyone in the household 19 years of age or older. It is also a requirement that if a child is enrolling on a family dental plan along with an adult that all children in the household are enrolled. Individuals or families enrolled on Medi-cal are not eligible to enroll in a family dental plan offered through Covered California.

Please Note: Family dental plans offered through Covered California cannot be purchased on a stand-alone basis. You must be enrolled on a health plan through Covered California to purchase a dental plan through Covered California. While you can purchase a health plan through Covered California that may qualify you to receive premium assistance, no financial assistance is available for the dental plans.

Based on your income and household size, you may qualify for Cost Sharing Reduction, which means you may be able to get improved benefits on the Enhanced Silver Plan you qualify for with no additional cost. You can get these improved benefits with any of the carriers listed below as long as you apply for a Silver Plan. View the Silver Plans in your quotes to see which Enhanced Silver Plan you qualify for.

Dental Service Embedded
(Pedi-Dental on Health Plan)
DHMO
(Optional to Add)
DPPO
(Optional to Add)
Pricing No charge for child;
n/a for adult
Cheaper that DPPO
Sonoma Co:
$13 adult; $16 Child
Most Expensive
Sonoma Co:
$52 Adult; $30 Child
Preventive and Diagnostic (x-rays, exams, cleanings, & sealants) for adults & kids No charge No charge No charge
Fillings, root canals, crows, and other major treatments 20% Basic Services
50% Major Services
Copayments, i.e.
$25 Filling
$300 Root Canal
Coinsurance, i.e.
20% Filling
50% Root Canal
Medically-necessary ortho (child only) 50% after ded $350 no ded 50% after ded
Is out-of-network covered? Appears to follow health plan, i.e. if PPO vs HMO No Some
Deductible Same as Health Plan None $50 per adult
$65 per child
Waiting periods For some major services. None Adult 6 mos for major services; Child – None
Max Out-of-Pocket – What member pays Same as health plan $350 Indiv; $700 Fam (2 or more kids) Adult – Non
Child – $350 Indiv, $700 for 2 or more kids
Annual Limit/Maximum Allowed Amount – What carder pays Same as health plan None Adult – $1500
Child – None