2018 Dental PPO Insurance Review Rates And Plans

There are many competitively priced dental PPO plans to choose from in California.

Many clients ask me if the Covered California dental plans are worth the money. The value of any insurance product is relative to the experience and concerns of the individual. However, for the money the Covered California dental PPO plans compare favorably to off-exchange dental insurance in benefits and are priced competitively. But there are plenty of off-exchange dental plans that consumers should consider even if they can enroll in dental insurance through Covered California.

There are only two types of dental insurance plans through Covered California: PPO or a HMO dental plan. Regardless of the carrier, the PPO and HMO plans are exactly the same. The only differences are the network of dentists, the monthly rate, and the customer service of the carrier. The HMO dental plans through Covered California haven’t changed too much from 2017 that has a list of specific procedures with a defined copayment schedule. In a sense, what you are buying when you enroll in a dental HMO plan is the set fee schedule for lots of dental procedures.

Covered California Compared To Off-Exchange Dental Plans

For the PPO plans, Covered California has approved a better-than-average benefit plan. The significant differences are reduced waiting periods for some dental services and a high maximum plan benefit dollar amount of $1,500. These better-than-average benefits are reflected in the monthly rates making Covered California PPO dental plans some of the most expensive on the market.

Too often I get calls from people who have been advised they need really expensive dental work and want dental insurance immediately to pay for their dentist bills. That’s like trying to buy home insurance as the wildfire is racing down the hill toward your home. It’s called adverse selection and all dental PPO plans have mechanisms built in to shield them paying out on large claims only to have the member cancel their coverage after the dental emergency is over. Waiting Periods are the standard tool to prevent individuals from only getting dental insurance when they most need it.

The waiting periods for minor or major services can be waived if a consumer has dental insurance. An individual can enroll in a relatively low benefit plan and then step up to higher benefit plan if major dental services are necessary. The waiting periods are waived because the person had dental insurance, even if they were at lower benefit levels. Always check the carrier’s documents to make sure that if you need to upgrade dental plan, the waiting periods will be waived.

Basic 2018 Dental Benefits Of Similar Plans

Basic dental PPO plan benefits comparison table for 2018 plans from Covered California, Delta Dental, Anthem Blue Cross, and Blue Shield.

Delta Dental coinsurance divisions are for years 1, 2, and 3.

I compared the basic dental benefits between Covered California, Delta Dental, Anthem Blue Cross, and Blue Shield. You can only enroll in the Covered California dental plans if you have health insurance through them. You can enroll in any of the other plans at any time. I selected plans that matched as close as possible to the Covered California standard dental PPO plan design.

Off Exchange Dental Plan Review

There a lots of different dental plans off-exchange or outside of Covered California. The number of plans makes comparisons complicated and confusing. Delta Dental and Anthem Blue Cross offer dental plans through Covered California and a variety of different plans off-exchange. The single largest difference between the Covered California plans and the ones offered off-exchange is the 12 month waiting period for major dental work such as extractions, root canals, and crown. The six month waiting period usually applies to minor restorative work such as getting a cavity filled.

As with all the plans, you can still use the dental plan for minor or major dental work before the waiting period is complete, you just won’t get any help paying for the service in the form of a cost-sharing coinsurance percentage. You will get the plan’s negotiated rate with in-network dentists even if the dental plan is under no obligation to pay a coinsurance percentage.

Delta Dental

Delta Dental has probably one of the largest networks of dentists of any dental carrier. But they have two networks, Dental PPO and Dental Premier PPO network. Delta Dental only offers their less exclusive Dental PPO network with the Covered California plans. A unique feature of the Delta Dental individual and family plans is a graduated coinsurance schedule. The longer the consumer keeps the plan, the lower their costs will be for dental services. By year three, and forward, Delta Dental members are paying coinsurance percentages equal to the other plans. Plan members are rewarded for persistency.

Delta Dental individual and family plans are only available through the Morgan White Group under website Dental For Everyone. When you enroll, you actually join an association with a group number. The member ID number is the social security number of primary applicant.

Blue Cross And Blue Shield

Both Blue Cross and Blue Shield share the Delta Dental waiting period for minor and major service coverage. However, both of those plans have a lower maximum annual dollar benefit paid per member at $1,250 compared to $1,500 for Covered California and Delta Dental Platinum Premier.

With either of the Blue Cross or Blue Shield dental plans, you enroll directly with the carrier. The dental plans are separate from any health plan you may have with the carrier. Even if you leave the carrier’s health plan, you can still maintain the dental plan.

Individual Dental Insurance Rate Comparison

Individual dental PPO plan rates in California for Covered California, Delta Dental, Anthem Blue Cross, and Blue Shield

Most health plans include children’s dental benefits. There may be no reason to purchase dental insurance for dependents if the health plan covers their dental needs. Rates are as of December 2017 for 2018. Rates subject to change.

While I used a 40-year-old for rate comparison, some dental plans don’t differentiate based on age or gender. When comparing the rates for the different dental plans across three different California regions it is immediately evident that the Delta Dental Premier plan rates are higher. A big part of this is the larger network of dentists in the Premier network. However, the Delta Dental PPO rate though Covered California is comparable to the same exact plan offered by Anthem Blue Cross. While the Covered California dental plans have a good benefit design, if you leave Covered California, you don’t get to carry the dental plan off-exchange.

The off-exchange Anthem Blue Cross Dental Blue PPO Enhanced 1JZ6 plan is comparably priced to the CC plan in Northern California, but more expensive in Southern California. Technically, it would make sense if all the exchange plans were priced less than CC plans because of the additional waiting periods and reduced maximum plan benefit dollar amount.

The Blue Shield Dental PPO Enhanced 50/1250 is priced 30% below its competitors, making it a relative bargain. Of course, now that we have mentioned the low price of the Blue Shield dental plans, they will probably have a rate increase next year. There may be concrete reasons why the Blue Shield plan has a lower rate than its competitors that doesn’t show up the plan benefit comparison. Contact your local dentist and ask which dental insurance plans they prefer to deal with.

Variety Of Dental Plans

But these aren’t the only plans from these carriers. Delta Dental offers Gold PPO and Gold Premier PPO plan at a lower price per month. Both Blue Cross and Blue Shield also offer dental plans with lower deductibles and a lower maximum annual benefit level of $500. There is are also some immediate benefit plans that don’t have waiting periods, but will have higher monthly rates. If the dental plan is on the hook to pay less over the course of the year, then the rates will generally be lower. If you don’t need orthodontia services, then selecting a dental plan that doesn’t cover braces can also save money.

Some people don’t need a benefit rich dental plan. Their main use is the regular x-rays, cleanings, exams. Many people have calculated that their excellent dental health means they pay more for dental insurance than they will receive in benefits. That is a valid reason for opting out of dental insurance. Then there are other people who need dental insurance to force us to go for our regular cleanings. Occasionally, usually as we get older, dental insurance helps ease the cost of 20-year-old fillings that need to be replaced or the unexpected crown or root canal.

Check with your dentist to see which dental plans he or she accepts. Just because they accept all PPO plans doesn’t mean any PPO plan is the best value. You will get the biggest bang for your dental insurance premium by having the dentist in-network. With a network dentist you won’t have to pay for amounts not covered by the dental insurance because the dentist has agreed to charge only allowable amount of the dental plan.

For more information and quotes, please see my IFP Dental Insurance Page.

Delta Dental Plans Through Dental For Everyone

Anthem Blue Cross Dental Plans

Blue Shield Dental Plans

Covered California Dental Plans