Reviewing Covered California’s 2016 family dental plans

Kevin Knauss

9 years ago

2016_California_family_dental_review Covered California has finally been able to include family dental plan enrollment to consumers who have purchased a health plan through the exchange. The dental plans overall are pretty good but they come with some conditions that limit suitability for all families.

2018 Dental Insurance Plan Rates and Review…Read More.

Covered California family dental generates revenue

Covered California doesn’t have to offer family dental plans and all health plans include pediatric dental benefits for dependents less than 19 years of age. However, the dental plans add another revenue stream for CoveredCA.com in that the dental plan will pay $0.83 for each individual enrolled every month to Covered California. The forecast is that if 50,000 individuals enroll in the family dental plans Covered California could receive $500,000 in revenue for 2016.

No subsidy for family dental

There will be a mix of Dental HMO and Dental PPO plans offered to families who purchased health insurance through Covered California and are eligible for the Premium Tax Credit Subsidy. There is no tax credit subsidy for the dental plans. Adults and children who are eligible for Medi-Cal can’t enroll in a family dental plan.

Carrier	Plan	Types
Access Dental Plan	HMO
Anthem Blue Cross		PPO
Delta Dental of California	HMO	PPO
Dental Health Services	HMO
Premier Access		PPO

Dental plans not in all regions of California

Not all of the dental plans are available in every part of California and rates will vary by region. While Covered California has given an estimate of the number of dentists in each plan within their 2016 family dental plan booklet, it doesn’t give the number of dentists within the plan within a region. The booklet does break down by zip code which plans are offered in that specific area. Download booklet at end of post.

Carrier	Dentists	Pediatric Dentists	Specialists
Access Dental Plan	4,354	396	1,300
Anthem Blue Cross	10,558		26,660
Delta Dental PPO	12,339	427	3,107
Delta Dental HMO	3,658	261	1,143
Dental Health Services	4,391	305	1,629
Premier Access	12,357	508	1,982

Dentist figures from Covered California family dental booklet.

Dental plans restricted by zip code

Another shortcoming of the Covered California plan is, at least in the Shop and Compare Tool, only dental plans for the consumer’s zip code are shown as being available for enrollment. In some zip codes, only two dental plans are offered. Unfortunately, a consumer may frequently travel to another zip code for work that may have all six dental carriers available. But the Covered California system precludes the individual or family from enrolling in those plans.

Dental plans offer competitive plan design

In general, the Covered California family and child dental plan design is comparable to dental plans found in the open market. Similar to health insurance, families can’t enroll in Covered California dental plans outside of open enrollment. However, anyone can enroll in a dental plan at anytime in the open market. The rates are fairly comparable as well, although it is difficult to exactly match the Covered California plan design because it is slightly different from the plans the carriers are offering off-exchange.

As a general comparison, I looked at rates for a family of four, two adults and two children, in the 95608 zip code of Sacramento County.

Zip Code 95608
Family of Four	Access Dental HMO	Dental Health Services HMO	Delta Dental HMO	Anthem Blue Cross PPO	Premier Access PPO	Delta Dental PPO
Adult	$13	$14	$14	$52	$56	$56
Adult	$13	$14	$14	$52	$56	$56
Child	$16	$13	$16	$30	$41	$32
Child	$16	$13	$16	$30	$41	$32
Monthly Premium	$58	$54	$60	$164	$194	$176

The dental HMO plans are half the cost of the dental PPO plans, but the PPO plans usually have twice as many dentists. Below are rates for the plans for the same family (2 adults, 2 children) that most closely match that of the Covered California plans available for purchase directly from the carrier.

Off-Exchange Plans	Plan	Monthly Premium
Access Dental	Individual DHMO Plan PA2	$24.97
Dental Health Services	Super Smart Smile HMO	$37.90
Anthem Blue Cross	Dental Prime Plan C PPO	$175.25
Delta Dental	Delta Dental Immediate Premier PPO	$172.59
Delta Dental	DeltaCare USA CAA54 HMO	$217.56

$1,500 maximum annual benefit

One of the reasons the PPO Covered California plans are expensive is the $1,500 annual maximum benefit. This is the amount that in a calendar year the dental plan will pay on an individual’s behalf. This large benefit would come in handy if the individual needed major dental work like a root canal or crown. Otherwise, there are dental PPO plans with a lower benefit maximum, such as $500, which have a lower monthly premium.

Dental plans

Premier Access and Access Dental are part of the Premier Life dental insurance company. Access Dental is their HMO product and Premier Access is the PPO product that has traditionally been marketed to employer groups and not available to individual consumers. As of October 2015, the Premier Life website had the most comprehensive information regarding the Covered California dental plans. While I’m sure the other carriers, some of whom have absolutely nothing posted, will eventually add supporting documents, it’s hard to really become an informed consumer when the manufacturer doesn’t even release any information about the product they are trying to sell.

Access Dental also runs a series of dental offices in Carmichael, Chico, Fairfield, Merced, Modesto, Sacramento, Redding, Santa Rose, Stockton, Vallejo, and Yuba City. They will promote their dentists first in a general search for providers on their website.

Dental Networks

Access Dental Premier Access Dentist Search

Anthem Blue Cross Dentist Search

Dental Health Services Dentist Search

Delta Dental Dentist Search

One issue is the dentist network. Like the individual and family health plans, will some of the carriers limit the number of dentists in the network for the Covered California plans? With the ability to search for dentist specific to the Covered California on the carrier’s website this is question is difficult to answer.

Anthem Blue Cross offers a variety of individual and family plans to the point of being overly confusing. But they do have a large network of dentists. Dental Health Services is somewhat of a mystery. They do have some documentation regarding the Covered California plans on their website. Delta Dental primarily focuses on the employer group market. They offer their individual and family PPO products through General Agencies such as Dental For Everyone. They also have two different networks of dentists: Delta Dental PPO and Delta Dental Premier. The larger Premier network has twice as many dentists and the plans are more expensive.

Customer service

One item rarely discussed or rated is customer service. I haven’t worked with all the carriers but some shine more than others. Anthem Blue Cross has lots of customer service representatives that can handle both medical and dental questions. Premier Life has gotten pretty good reviews from other folks I’ve talked to. Delta Dental is a large bureaucracy which has been difficult to communicate with on a variety of issues. While their dental plans and service are highly rated, the customer service aspect needs some work on the individual and family side.

Covered California Dental Plan Highlights

Purchase Requirements

Childless adults are allowed to purchase family dental plans.
At least one adult aged 19 or older must enroll.
If a family enrolls one child younger than 19, they must enroll all children.

Important Adult Benefit Details

Adult preventive and diagnostic services are available at no cost, and are not subject to deductible.
Adult dental benefits are not essential health benefits, which means there is no out-of-pocket maximum for adult members.

Dental HMO (DHMO) Plans

Offers member copays and lower premiums.
There is no deductible, waiting period or annual benefit limit in the DHMO plans.
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.

Dental insurance is nice if you can afford it

Regular dental check-ups and preventive cleanings are important whether you are a child or adult. If your children have private health insurance you should at least try to use the pediatric dental and vision benefits included in the plan. If you are unsatisfied with either the dentists or the dental care, then consider purchasing additional dental coverage. For families with children in Medi-Cal, the only alternative is to purchase an off-exchange dental plan not through Covered California.

One of the first filters in choosing a dental plan should be to check if your favorite dentist is a network provider. While a dental PPO will usually offer some out-of-network dental benefits, you are not maximizing your dental premiums by only being partially reimbursed for out-of-network services if your dentist is not in-network with the plan. Because Covered California seems to be limiting a family’s dental plan options by their zip code, there may be better plans found off the exchange.