Delta Dental is expanding the availability of their individual and family plans in California. Families who don’t have access to a group dental plan or Covered California can enroll in several of Delta Dental’s PPO and HMO plans directly. The premiums for 2019 are competitive relative to the coverage benefits, dentist network, and maximum dollar benefit of other dental insurance plans on the market.
Delta Dental PPO and HMO California Dental Plans
The value of dental insurance is questionable in the minds of many consumers. And I don’t necessarily disagree with that evaluation. However, the importance of regular dental exams, cleanings, and hygiene cannot be disputed. If dental insurance keeps a person on track with good dental hygiene and habits, they will be spared the expense of expensive dental procedures in the future.
The approach of inculcating good dental hygiene is the basis for virtually all health insurance plans to cover pediatric dental. You should only consider purchasing dental insurance for your children if the dental coverage in their health insurance does not meet your requirements for your preferred dentist or proximity to a network of dentists. Otherwise, the pediatric dental insurance in the health plans is pretty good.
Individuals can enroll directly with Delta Dental in one of their PPO or HMO dental plans. California direct Delta Dental plans use their PPO network of dentists. There is also a Premier network and those plans are available through Dental For Everyone and usually have higher monthly premiums.
PPO Dental Insurance
The Basic plan is focused on diagnostic and preventive services with very little coverage for major dental services. The Basic plan will cover 100% of exams, cleanings, x-rays, and sealants. It will cover 50% of minor restorative procedures like fillings, which has a 6-month waiting period. The maximum calendar year dollar benefit is $1,000.
The Premium plan, in addition to the covered benefits of the Basic plan, includes coverage for root canals, gum treatments, oral surgery, bridges, dentures, implants, crowns and orthodontics. These are all considered major restorative procedures and have a 6-month period. Simple fillings are covered at 80% under the Premium plan, while major service include 50% coverage. The annual maximum amount is $1,500 under the Premium plan.
Dental implants are expensive and not covered under most dental insurance plans. Some dental plans will cover implants up to the cost an alternative prosthodontic such as a bridge or denture. The Premium plan includes language in their disclosure form that indicates coverage for a dental implant. However, you will want to work with your dentist to get an estimate for the implant and have Delta Dental estimate their cost-sharing for the prosthodontic.
(2) Prosthodontics: Services include materials and procedures for construction of fixed bridges, partial or complete dentures, pontics, and the repair of fixed bridges; implant surgical placement and removal; and for implant supported prosthetics, including implant repair and recementation. Services for implants include procedures for endodontic endosseous, endosteal, eposteal and transosteal implants; implant connecting bars and implant repairs.
(18) Periodontal limitations:
- c) Periodontal Services, including bone replacement grafts, guided tissue regeneration, graft procedures and biological materials to aid in soft and osseous tissue regeneration are only covered for the treatment of natural teeth and are not covered when submitted in conjunction with extractions, periradicular surgery, ridge augmentation or implants.
For both plans, the waiting periods are waived with proof of prior dental coverage.
The dental plan rates are good through July 2019. PPO plans can be paid monthly, quarterly, or annually. DeltaCare premiums must be paid annually.
HMO Dental Insurance
A less expensive dental insurance option are the Delta Dental DeltaCare USA HMO dental plans. Under the HMO design the member specifies a dentist or dental group at which they will receive services. Similar to the PPO plan, many of the diagnostic and preventive services will have a $0 copay. All the other services will be billed according to a fee schedule. This allows the consumer to know exactly how much they will be paying for certain dental procedures. Unlike the PPO plans, there is no waiting period for most dental services.
Dental HMO plans are great if you can locate a dentist within a reasonable distance from your home or work. In rural or semi-rural areas there may not be many dentists participating in an HMO dental network. But I’ve had several clients who have found HMO dentists in their area and like the services and value of the HMO dental plans.
If your dentist is only in the Delta Dental Premier network, then you can find those plans on Dental For Everyone.
See if your dentist is in network for one of the dental insurance plans https://www.deltadental.com/us/en/find-a-dentist.html
Delta Dental Summary of Benefits