Covered California Dental Plans
As a California resident, if you have a Covered California health plan, you and your family can also sign up for a Covered California dental plan. The plans are very affordable, and the enrollment process works the same way as a health plan. Here are some details about the dental plans in California and how they work. If you want to learn more about the Covered California program you can find more info here.
Free Resource: Certified Enrollment Counselors
You can call or chat with a Covered California representative 24/7 on CoveredCA.com to learn more about your options.
Additionally, United Way has a free resource of Certified Enrollment Counselors that can help you if you have very specific insurance needs. You can reach out to a Counselor directly here.
How Do Covered California Dental Plans Work?
Covered California dental plans are separate from Covered California health insurance plans. Dental coverage is not considered an essential health benefit for adults, but it is for children. So if you need pediatric dental care, it’s taken care of in your Covered California health plan. If you need adult dental coverage, then a Covered California dental plan is right for you.
Covered California offers two types of dental plans: DHMO and DPPO plans. For both types of plans, preventive, diagnostic and treatment services are covered at no cost for both adults and children.
No financial assistance is available to purchase Covered California dental plans, and there is no maximum out-of-pocket limit for enrolled adults.
Who Can Enroll in a Covered California Dental Plan
- Adults over the age of 19 who are enrolled in a Covered California health plan
- Spouses of individuals enrolled in a Covered California health lan
- Children of any adult that is enrolled in a Covered California dental plan. Note, if one of your children enrolls, all children in the household must enroll.
- Exceptions: Medi-cal members aren’t currently able to enroll in these plans
It’s important to note that you can’t purchase a family dental plan without a Covered California health plan. Also, there is no premium assistance available for dental plans.
Key Dental Benefits
- All Covered California dental plans contain the same standard benefits, but there is variation when it comes to more extensive coverage.
- All plans cover diagnostic services like x-rays and exams and preventive services like cleanings and sealants, as well as root crowns and root canals.
- Covered: oral exams, cleaning, x-rays, gum maintenance, gum scaling and root planting, fillings, crowns, root canals, extractions, fixed bridges and dentures.
- Never covered: veneers, implants, tooth whitening and adult orthodontics.
- Sometimes covered: TMJ, maxillofacial prosthetics, crown lengthening, bonding and cosmetic dental care.
- Because children’s dental health is considered “essential” some of their dental services will be completely free.
- Free: preventive and diagnostic services, such as X-rays, exams, cleanings and sealants
- Partially covered: fillings, root canals and crowns
Note: Your children will still keep the dental insurance that’s listed in your Covered California health plan. But adding them to your family dental plan could give them access to more dentists and specialists, as well as more coverage.
You can look at more coverage details here.
Selecting a Covered California Dental Plan
When you select your dental plan, you need to first consider the insurance provider and the type of plan. Beyond that, the primary differences among the plans are the frequency and amount of services that are covered within the year.
There are a number of choices for dental insurance providers: Access Dental Plan, Anthem Blue Cross, California Dental Network, Delta Dental of California, Dental Health Services, Liberty Dental Plan and Premier Access. Each have different networks of doctors and different coverage packages.
The two types of plans available are DHMO and DPPO. DHMO plans require you to sign up for a primary dental care provider and go through that provider for the services you need — they are cheaper. DPPO plans give you greater access to a wider network of California dental providers so you have more flexibility — they are more expensive.
DHMO Dental Plans
For these plans there is no deductible and no annual limit on what your plan will pay for your care. The costs for fillings, root canals, crowns and other major treatments and services are split by you and the dental plan, according to set copay amounts. However, you have to work with a dental provider inside the plans’s specific network. If you have a favorite dentist, make sure you sign up for a plan where they’re in-network.
These plans are cheaper and are a good choice if you’re ok with having a stricter network of dental service providers.
DPPO Dental Plans
On PPO Covered California dental plans, there is a $50 deductible for each enrolled adult. The costs for fillings, root canals, crowns and other major treatments and services are split by you and the dental plan according to a set percentage (e.g. 20% for a filling or 50% for a root canal), instead of a set copay. You can get some coverage for dental providers that are outside the plan’s specific network, and you might have a longer list of in-network dental providers than you would get in an HMO plan.
One thing that’s important to note for the PPO plans is adults might have to wait for six months on some benefits, and you might only get services covered up to the amount of $1,500 per year. Be sure to check each plan specifically.
These plans offer more flexibility if you need specialized care, but they cost more in the long run.
You can compare Covered California dental plans here.
Family Dental Plans
Covered California dental plans often have a larger network of dental service providers than your Covered California health plan does, and it can be helpful to have the family on the same plan. Family dental plans can also be more affordable if you have multiple adults within your household. Just note that if you include one of your children (under 19 years old) in your family dental plan, all children younger than 19 who live in your household will need to enroll.
Where Can I Enroll
If you’ve already purchased a Covered California health plan log into your Covered California account. Under the plan selection tab you will be given the option to shop for a dental plan or opt out of dental insurance.
If you are signing up for Covered California health care for the first time, you can buy your dental insurance at the same time. You can look at both using the Shop and Compare Tool and put both plans in your cart. You’ll be asked to fill out an application and set up a Covered California account to enroll.
If you need more detailed support, you can reach out to a free Certified Enrollment Counselor here.