How Does Dental Insurance for Children Work in California?

Tooth decay is a common chronic condition for children in the U.S. and children’s dental health is more critical than many people realize. The Affordable Care Act includes pediatric dental care as an essential health benefit, and it’s important that you can take advantage of the benefits you already have in your health plan.

Dental insurance for kids is built into every Covered California health insurance plan. So if your children are on your Covered California healthcare plan, they have dental care benefits. These pediatric dental benefits are “embedded” within the health insurance plan, which means that it may be a different insurance company that provides the benefits, but it’s connected to your Covered California health plan.

Note: Adult dental care is not considered essential, so if you’d need to enroll in a separate Covered California dental plan for adult dental benefits. You can find more information here. If you want to learn more about Covered California’s marketplace, you can find more info here.

Free Resource: Certified Enrollment Counselors

If you want free help figuring out your children’s exact benefits, United Way has Certified Enrollment Counselors that you can reach out to directly here. You can also call or chat with a Covered California representative at CoveredCA.com for basic plan questions.

Benefits

No matter what health plan you have, your kids will get the following pediatric dental benefits:

  • Preventative care like cleanings and sealants
  • Diagnostic care like X-ray, oral exams, tests

In addition, you may receive benefits for more on your plan, depending on your provider.

Coverage details

  • Preventative and diagnostic services are free (not subject to deductible)
  • 20% of basic dental care covered
  • 50% of major dental care covered
  • 50% co-insurance for orthodontics (after-deductible)
  • Crowns, root canals and fillings costs shared
  • No out-of-pocket maximum for care
  • Care could count towards your health plan’s maximum out-of-pocket limit

The costs of many dental services are different for different health plans, so make sure to check your specific plan.

Dental Insurance Plans Included

Depending on the health plan you choose, your child will enjoy dental benefits offered by one of the companies below. Unless you have an Anthem Blue Cross plan, which has its own dental policy, you will be receiving pediatric dental insurance from a separate dental insurance company — meaning you’ll have one insurance company covering your family’s health benefits, and one company covering your children’s dental benefits. You do not have to pay more for this.