For individuals and families who enroll in a health plan through Covered California they may also select a family dental plan. Any monthly subsidy awarded to the family for health insurance is not applied to the dental plan. Only household members eligible for the APTC monthly tax credit are able to enroll in an on-exchange Covered California dental plan. This means children who are Medi-Cal eligible or adults who have other coverage such as Medicare can’t be included in the family dental plan.
Covered California Dental Plan Benefits
Dental HMO (DHMO) Plans
- Offers member copays and lower premiums
- No deductible, waiting period or annual benefit limit
- Out-of-network services are not covered under this option
Dental PPO (DPPO) Plans
- Offers member co-insurance, some out-of-network benefits and more choices in providers
- Adult dental benefits in DPPO plans include a six-month waiting period for major services
- Adult dental benefits in DPPO plans are subject to a $1,500 annual benefit limit
This is the most the plan will pay for an individual adult member’s dental care for the benefit year
Covered California embedded children’s dental coverage with each health plan for 2017.
Children’s (Pediatric) Dental is one of the ten Essential Health Benefits
All health plans on the Individual Market include children’s dental benefits for members younger than 19 years
- Free diagnostic and preventive services
- Comprehensive coverage for basic and major treatment services, not subject to a deductible
The HMO plans don’t have coinsurance, they have a set copayment schedule for included services. There is no waiting period for covered major services. There is a six month waiting period for covered major services with the PPO plans.
Dental HMO plans usually have a limited number of dentists participating in the network relative to Dental PPO plans. But it is best to search the provider directories to learn if you current dentist is in-network or for a provider near your residence.
Access Dental Provider Search (Select State Exchange Plans Dental HMO)
https://www.premierlife.com/secure/PAWEBSITE.PROVIDER.UI/WBSPrvNewSearch.aspx?logarea=Member
Anthem Blue Cross PPO Provider Search
http://www.geoaccess.com/awp/Dental/PO/begin.asp?Gateway=False&st=DV&Company=BC&netcode=DVP
California Dental Network Provider Search
http://www.caldental.net/FacilitySearch2/cdn/ca
DeltaCare HMO Provider Search (Select DeltaCare USA)
Delta Dental PPO Provider Search (Select Delta Dental PPO Plans)
Dental Health Services Provider Search
Premier Access PPO provider search (Select State Exchange Plans Dental PPO)
https://www.premierlife.com/secure/PAWEBSITE.PROVIDER.UI/WBSPrvNewSearch.aspx?logarea=Member
Dental plan documents available for
- Access Dental HMO
- Anthem Blue Cross Dental PPO
- California Dental Network HMO
- DeltaCare HMO
- Delta Dental PPO
- Dental Health Services HMO
- Premier Access PPO
