Covered California consumers may have realized that Delta Dental offers two different adult dental HMO insurance plans. The Delta Care HMO plan direct from Delta Dental is less expensive than the HMO plan offered through Covered California. Are they the same plan and why is there a rate difference?
Comparing The Two Delta Dental California HMO Dental Plans
The adult Delta Dental HMO plan direct from the carrier is $8.92 per month, while a Delta Dental HMO plan through Covered California is $14.24 (based on a sample Southern California zip code.) In terms of pricing and payments, there are a couple of differences. First, the DeltaCare USA HMO plan direct from the carrier requires one annual payment. Covered California enrollments can be billed on a monthly basis. Second, direct enrollment has a one-time $10 enrollment fee. Covered California plans have no enrollment fee.
Even with the cost of the enrollment fee added to the direct enrollment rate ($9.75), the Covered California DeltaCare plan costs 46 percent more. Is the extra cost of the Covered California dental HMO plan worth the extra money?
Rates and fee schedules based on information available as of February 2023 for adult enrollments.
All HMO dental plans are structured with no deductibles and no maximum benefit amount. All dental services are subject to a published fee schedule. Dental HMO plan members must select an HMO dentist within the network to receive their dental care and for referrals to dental specialists.
It appears that both the Covered California Delta Dental HMO and the plan direct from the carrier share the same network of dentists under DeltaCare USA network. What is different is the fee schedule for dental services. Covered California developed their own fee schedule for dental services that is universal to all of the HMO dental plans offered. The direct (also known as off-exchange) Delta Dental HMO fee schedule is slightly different from the Covered California design.
Both plans have numerous services that are no cost to the plan member such oral evaluation some x-rays. There are some small price differences between the dental services and the direct Delta Dental HMO includes some dental services not offered through Covered California.
Lower Cost HMO Covers More Dental Services
One cost that pops out is that the direct Delta Dental HMO plans has several services that require a $5 copayment such as when you visit the dentist for a cleaning. Sealant repair per tooth is not covered by the Covered California plan and costs $22 under the direct plan. The direct plan lists 1 surface amalgam filling at $15, while the Covered California fee is $25.
However, if you want to upgrade to a resin-based filling, the direct Delta Dental plan will cost you $35, but only $30 if you have the Covered California plan. A porcelain/ceramic crown costs $75 more with the direct HMO plan over the Covered California design. The lower cost crown of porcelain over based metal is $50 less with the direct plan.
Root canals are higher by $40 under the direct plan. Gingevectomy or gingivolplasty for 4 teeth is considerably higher under the direct HMO plan by $110. Periodontal scaling is slightly less under the direct plan by $5. A complete maxillary denture is $95 more with the direct plan. If you need a tooth extracted, the Covered California plan could be less expensive by $15. The Covered California plan covers no adult orthodontia unless medically necessary. The direct Delta Dental HMO plan does include adult orthodontia or braces. Neither plan covers dental implants. If you need a whiter smile, the direct Delta Dental HMO plan includes custom trays for the home bleaching process at a $125 fee.
This is only a small sampling of diagnostic codes and the fee or coverage associated with either the Covered California of direct Delta Dental HMO plan. Any cost savings will be dependent on the dental care a specific member may need. For adults who know they need some fillings, crowns, root canal, or extractions – and they have a Covered California health plan – the Delta Dental HMO plan through Covered California could save some money.
Only the Covered California HMO Plan Has A Maximum Out-of-Pocket Amount
Perhaps the most significant difference between the 2 plans is that the Delta Dental HMO plan through Covered California has a maximum out-of-pocket amount for pediatric dental services. Once a dependent accrues $350 in dental expenses during the year, they have met their maximum out-of-pocket amount and dental services are covered at no cost for the remainder of the year. The off-exchange Delta Dental HMO plan does not include the maximum out-of-pocket amount benefit.
The off-exchange, direct from Delta Dental, DeltaCare USA HMO dental plan represents a good value for routine dental maintenance and occasional restorative dental services. Over several years, enrolling in the off-exchange Delta Care HMO plan will save some money on premiums, if not reduced costs for some dental services.
