Who are the dentists in the new Covered California dental plans?
Covered California is changing and expanding their dental plans. First, all health plans will include children’s dental insurance. There will be no need to purchase a separate dental plan for dependents 18 and younger. Second, Covered California will begin to offer family dental plans on the exchange. But who are these dental plans and are they any good?
Children’s dental embedded
Covered California fumbled the ball in 2014 by making pediatric dental optional for parents to purchase for their children. In addition, the enrollment website didn’t prompt families to select a pediatric dental plan until many people had already enrolled. Covered California finally decided to follow the off-exchange family and small group market by embedding the children’s dental right into the health plans for 2015.
Health Insurance Plan |
Pediatric Dental Coverage |
| Anthem Blue Cross | Anthem Blue Cross |
| Blue Shield | Blue Shield |
| Chinese Com. HP | Delta Dental |
| Health Net | Dental Benefit Providers |
| Kaiser | Delta Dental |
| Molina | California Dental Network |
| Sharp | Access Dental Plan |
| Valley HP | Liberty Dental Plan |
| Western Health Adv. | Premier Access |
Partner plans
Each health plan will either offer their dental plan or a dental plan they have partnered with to support the pediatric dental benefits. Some of the details of these plans haven’t been released either by Covered California, the health plans, or the dental insurance companies. We do know that the embedded dental benefits for children will be the High or 85% value similar to the 2014 standalone plan. DHMOs require the members to select a primary dentist for most dental services. After the deductible, most services have a set copayment amount. DPPOs allow you to go to any dentist in the network and there can be some out-of-network coverage. After a deductible, member costs are coinsurance percentage such as 20% or 50% of the negotiated rates.
| 2014 High 85% Plan Benefits | ||
| Children’s Dental | DPPO | DHMO |
| Diagnostic and Preventive | 0% | 0% |
| Office Visit | N/A | $0 |
| Basic Services | 20% | $40 |
| Major Services | 50% | $365 |
| Orthodontia | 50% | $1,000 |
| Deductible | $50* | none |
| Annual Maximum | none | none |
| Out-of-Pocket Maximum | $1,000 | $1,000 |
| Diagnostics and preventive includes x-rays, exams, cleanings and sealants. | ||
| Major Services include crowns, prosthodontics, oral surgery. |
But the specific coverage hasn’t been released. It might actually mirror the children’s dental plan coverage of the family plans to be offered in 2015. It’s also unclear if parents can choose a DHMO or DPPO for their children if it is offered by the insurance company. For example, Blue Shield will offer a DHMO or DPPO option for their family plans.
DHMO: Dental Health Maintenance Organization
DPPO: Dental Preferred Provider Organization
Who are the dentists in the new dental plans?
However, if the dental insurance partnered with by the health plan only offers DHMO or DPPO that will be the only option offered for the embedded dental plan. The next issue is the provider network. Many of the dental plans have different networks of dentist for different plans. For instance, Delta Dental has far larger network of dentists for members of their group plans than they offer for their individual and family plan members. Just because a dental plan boasts of 100,000 dentists, doesn’t mean all those dentists will be available to be seen by children with pediatric dental benefits.
Will your family dentist be in-network?
It’s very possible that embedded children’s dental insurance offered by the health plan won’t support the current family dentist. DHMOs have notoriously thin provider networks, even though the copay structure is very favorable. Consequently, the embedded pediatric dental plan may be of little value to the family. Until Covered California or the plans release more detailed information on their networks, families will just have to wait for specifics when they renew or enroll for 2015.
Covered California family dental plans
An alternative to the potentially slim dental provider network offered by the embedded pediatric dental plan is purchasing a family dental plan. (Perhaps a very narrow network of dentists might be a strategy by the health plans to get people to enroll in family dental). The family dentals plans are supposed to be released for enrollment by Covered California sometime in early 2015. The overall benefits and costs of the proposed family dental plans are very good. See: Covered CA Family Dental page for more information
| Family Dental Plans 2015 | ||
| Dental PPO Plans | Adult | Child |
| Services | ||
| Diagnostic and preventive* | 0% | 0% |
| Amalgam filling – one surface | 20% | 20% |
| Root canal – molar | 50% | 50% |
| Gingivectomy per quad | 50% | 50% |
| Extraction – single tooth | 50% | 50% |
| Crown – porcelain | 50% | 50% |
| Orthodontia | N/A | 50% |
| Plan Costs | ||
| Deductible** | $50 | $65 |
| Annual Benefit | $1,500 | none |
| Ind. Max. Out-of-Pocket | N/A | $350 |
| Family Max. O-o-Pocket | N/A | $700 |
| Office copay | $0 | $0 |
| Waiting period*** | 6 months | none |
| *Diagnostics and preventive includes x-rays, exams, cleanings and sealants. | ||
| **Waived for diagnostic and preventive | ||
| ***Major services can include crowns, extractions, gingivectomy, root canals, etc. | ||
| Dental HMO Plans | Adult | Child |
| Services | ||
| Diagnostic and preventive* | $0 | $0 |
| Amalgam filling – one surface | $25 | $25 |
| Root canal – molar | $300 | $300 |
| Gingivectomy per quad | $150 | $150 |
| Extraction – single tooth | $65 | $65 |
| Crown – porcelain | $300 | $300 |
| Orthodontia | N/A | $350 |
| Plan Costs | ||
| Deductible** | $0 | $0 |
| Annual Benefit | none | none |
| Ind. Max. Out-of-Pocket | N/A | $350 |
| Family Max. O-o-Pocket | N/A | $700 |
| Office copay | $0 | $0 |
| Waiting period | none | none |
| *Diagnostics and preventive includes x-rays, exams, cleanings and sealants. | ||
| **Waived for diagnostic and preventive |
Adult and child rates
The Covered California Family Dental Plans and Rate for 2015, which you can download at the end of the post, shows how the dental premiums for adults and children can vary by region. Even though the rates are fairly consistent for the different carriers from region to region, the big variations occur between the dental insurance plans. A review of the rates for Region 15, Los Angeles, displays the wide disparity of premiums between the carriers.
| Region 15 | Adult | Child |
| Access DHMO | $11.00 | $14.00 |
| Anthem DPPO | $59.20 | $33.60 |
| Blue Shield DHMO | $20.60 | $17.70 |
| Blue Shield DPPO | $30.10 | $8.00 |
| Delta Dental DHMO | $12.99 | $14.49 |
| Delta Dental DPPO | $54.99 | $31.99 |
| Dental Health Services DHMO | $12.40 | $12.50 |
| Premier DPPO | $40.00 | $28.00 |
See: Covered CA Dental Insurance page for all regions and rates.
Traditionally, DHMO rates are always lower than DPPO rates. Unless Covered California inverted the rates for Blue Shield, their DPPO rates are less expensive than their DHMO product. The Delta Dental rates are more indicative of the DHMO to DPPO rate spread. It’s interesting that some carriers have priced the child rate higher than the adult rate for the DHMO products. Anthem and Delta are the high price leaders for the DPPO plans. Obviously the carriers have chosen different pricing strategies to appeal to their target market.
Generous maximum benefit and out-of-pocket amount
A big driver of dental premium is the maximum benefit allowed. The $1,500 maximum benefit is higher than many individual and family dental plans. Another unique benefit is that there is a maximum out-of-pocket amount for the children. Once the child’s individual out-of-pocket maximum has been reached, the plan pays all costs for covered services for that child. The downside to the Covered California family dental plans is that all the children in the family must be enrolled.
Consumers need more information
Of course, just like the embedded pediatric dental coverage, if your preferred dentist doesn’t take any of the offered Covered California selections, then it may not be worth enrolling in one of them. It’s also unclear if there will be separate dental provider networks for these Covered California plans. Clearly, consumers need more information to determine whether they should buy a family dental plan in addition to the embedded pediatric dental for their children. Some will consider side stepping Covered California and go off-exchange to purchase a family dental plan that supports their family’s dentist.
[wpfilebase tag=file id=208 /]