California Dental Insurance Plans
Many dental conditions are preventable. But brushing and flossing alone is rarely enough. Regular dental visits support good oral care and dental insurance will help minimize the cost of needed services. Whether the dental coverage is to protect young children from tooth decay or older adults from chronic conditions, having a dental plan will minimize expenses.
Needing dental or orthodontic work done can feel like a drag when you don’t have dental coverage. Below are some basics on dental plans that will help you find the right dental health insurance policy for you, your family, or your small business.
Finding Dental Coverage in California
Health plans purchased through the Covered California Health Exchange automatically include pediatric dental benefits for children up to age 18. Many plans that are available off the Exchange also include pediatric dental insurance. Adults can get dental coverage in California by purchasing it as a supplement to their health insurance plan or on a stand-alone basis. Sometimes, stand-alone plans offer richer benefits. An exception is when the dental insurance is a supplement to a health plan that is purchased by an employer. Small business dental plans sometimes offer more benefits and orthodontia coverage may be less expensive to include. To find dental coverage, contact your Health Insurance Agent/Broker or your Human Resources Department, if your employer offers group health insurance.
Understanding Dental Insurance Terms
Here are some common terms used when talking about dental insurance. Becoming acquainted with them will help you in understanding California dental insurance policies and in choosing the one that is right for you.
A deductible is the amount that would be paid out of pocket before the dental coverage kicks in. For example, if the deductible on a dental insurance plan is $100, then the individual would have to pay the first $100 for services out of pocket before the insurance would cut down or discount any additional costs. Traditionally, a deductible usually does not apply to preventive services like routine dental cleaning and diagnostic X-rays. Some dental insurance plans do not have plan deductibles. When a deductible does not apply to a dental service, then, the patient pays a copay or coinsurance right away. Plans without deductibles tend to be more expensive.
- Copayment / Coinsurance
After the patient satisfies the deductible, the insurance company will pay a portion of the bill. The patient’s portion of the bill is called the “copayment” when it’s a fixed dollar amount, or “coinsurance” when it’s a percentage of the bill. Depending on the level of dental coverage and the exact procedures being performed, the patient’s share of covered dental visit can range anywhere from 20% to 50% of the final bill.
- Yearly Maximum
Another big term to consider is the “maximum” on each dental insurance policy. Generally, this is the most that the insurance company will pay in a calendar year. Maximums typically range anywhere from $750 to $2,000 per year. Usually, the more expensive the policy is, the higher the yearly maximum will be. Once a patient reaches the yearly maximum, the patient will be responsible for 100% of any remaining charges. Some of the richer plans do not have a yearly maximum.
- Consider Waiting Periods
Some dental services may be subject to a waiting period. During the waiting period, dental coverage would not apply to selected major dental services. A typical waiting period can be 6 months for fillings or crowns, or up to two years for braces or wisdom tooth removal. Once the waiting period is over, dental insurance would apply.
Basic Types of Dental Coverage Plans
There are two basic types of dental coverage in California:
- DMO (Dental Maintenance Organization)
This type of plan works similar to an HMO (Health Maintenance Organization) in that you would, mainly, receive services from a primary dental physician, who would coordinate your dental care and refer you to specialists in the network, as needed.
- PPO (Preferred Provider Organization) or PDN (Participating Dental Network)
With PPO or PDN plans, the patient chooses the dentist they want and the dental coverage follows them. As an option, patients in this type of plan may also see a networked dentist and pay lower fees for services.