Adult dental now available through Covered California

Covered California, California's health insurance marketplace for the federal Affordable Care Act, is now offering family dental plans to purchase for the 2016 benefit year. The standalone family dental plans are available in addition to the children's dental coverage included as an essential health benefit for consumers younger than 19 years old.

Covered California's open enrollment period for 2016 coverage began Nov. 1 and ends Jan. 31. Both adults and children can enroll in Covered California's family dental plans as an optional benefit. There is no tax penalty for consumers who elect not to enroll in the family dental plan, and no financial assistance (in the form of a tax credit) is available for purchasers of the family dental plan.

Families that wish to purchase a family dental plan must include at least one adult who has purchased health plan coverage through Covered California. Adults who have purchased health coverage through Covered California can purchase a family dental plan even if they do not enroll their child(ren); however, if a child is enrolled in a family dental plan, all children in the family under the age of 19 must be enrolled in the same dental plan.

There are two dental plan product types available for purchase, depending on where the family resides. This includes a dental preferred provider option (DPPO) and a dental health maintenance organization (DHMO). CDA advocated strongly to ensure patients throughout the state had options in the types of plans offered. The participating dental carriers in the family dental plans include Access Dental Plan (DHMO), Anthem Blue Cross (DPPO), Delta Dental of California (DPPO and DHMO), Dental Health Services (DHMO) and Premier Access (DPPO).

Family dental plan premium pricing will vary based on selected plan, (DHMO or DPPO) and the geographical area the consumer resides in. Adult premiums for family dental coverage range from $13 to $64.46 per month, and child premiums range from $16 to $48 per month. The family dental plans feature standard copayments, deductibles and coinsurance requirements for the most frequent services used. All of the family dental plans adhere to Covered California's standard benefit designs that include preventive and diagnostic treatment at no cost for both adults and children.  

Embedded Children's Dental Coverage

In 2016, children's dental benefits are automatically embedded in the health plan coverage available through Covered California, just as they were in 2015. The dental benefits plan is based on which health plan is selected. The 2016 embedded dental plans are listed in the below chart.  

dental plans chart 

What dentists need to know about embedded plans

As in the family dental plans, preventive and diagnostic services, such as X-rays, exams, cleanings and sealants are free for the patient and are not subject to the medical deductible for children enrolled in the embedded dental plans. The plan and the consumer, however, share costs for fillings, root canals and crowns.

Because there is no out-of-pocket maximum specific to children's dental costs, the total out-of-pocket costs for a child's dental care can accumulate to the health plan's out-of-pocket maximum limit ($6,500 for 2016 Bronze-level plans).

When coordinating benefits for children with Covered California embedded dental coverage through their health plan and family dental plan coverage purchased separately, the embedded dental plan is always the primary dental plan and should be billed prior to billing the family dental plan.  

Consumers are encouraged to review the dental plans' "evidence of coverage" and "certificate of insurance" documents prior to purchasing or enrolling children in a family dental plan to gain a better understanding of whether their children will benefit from dual coverage.

Small business health and dental plans

For those dentists considering purchasing health and dental coverage for themselves or their employees, Covered California for Small Business has six health insurance companies and seven dental plan options that are available for year-round enrollment. For 2016 coverage, businesses are eligible to purchase small group plans if the business meets the following criteria:

  • Has at least one but no more than 100 full-time equivalent employees and meets certain contribution and participation requirements.
  • At least one employee receives a W-2.
  • The majority of employees live in California.

Dentists operating as sole proprietors, with no W-2-receiving employees, may be eligible to purchase coverage through Covered California's individual marketplace.

For more information regarding Covered California's Dental Plan coverage, including the Embedded and Family Dental Plans and small business health and dental coverage available through Covered California, visit coveredca.com.

CDA member dentists can contact TDIC Sales at 800.733.0633, option 1 for assistance with small business health and dental plan purchasing.

Related Items

On Jan. 1, California and the nation began the second year of implementation of the Affordable Care Act (ACA). Despite the fact that we are entering into year two, there is still much uncertainty regarding the overall and long-term impacts of the ACA on both the medical and dental care insurance and delivery systems.

Covered California changes dental benefits
By Nicette Short, CDA Director, Public Policy
As California approaches the second full year of implementation of the Affordable Care Act (ACA), California’s Health Benefit Exchange Board, responsible for Covered California, the state’s online insurance marketplace and for the overall implementation of the ACA in California, has announced some changes to how dental benefits will be offered in 2015.