02/15/2016

Covered California dental enrollment exceeds 140,000


Enrollment in the family dental benefit plan product offered through Covered California, California's health benefit marketplace created by the federal Affordable Care Act, now exceeds 144,000 enrollees according to Covered California representatives. The open enrollment period for renewing and newly enrolling Covered California consumers ended on Jan. 31. Dental coverage has been a highly requested benefit from Covered California enrollees since the marketplace launched three years ago.  

Family Dental Plan Coverage

CDA strongly advocated for patient choice in selecting dental plans and dentists. As a result, Covered California offered two dental plan product types through the family dental plan program to enhance patient options: a dental preferred provider option (DPPO) and a dental health maintenance option (DHMO). While the dental plans offered vary throughout the state, the participating carriers in the family dental plan include the following:

  • Access Dental Plan DHMO
  • Anthem Blue Cross DHMO or PPO
  • California Dental Network DHMO
  • Delta Dental of California DPPO or DHMO
  • Dental Benefit Providers DPPO or DHMO
  • Dental Health Services DHMO
  • Liberty Dental Plan DHMO
  • Premier Access DPPO

As a reminder, there is no tax penalty for consumers who choose not to enroll in the family dental plan, and no financial assistance (in the form of a tax credit or subsidy) is available for purchasers of the family dental plan.

Embedded Dental Plans for Children's Coverage

For children under the age of 19 who have health coverage through Covered California, their primary dental coverage is embedded with their health coverage. There is no out-of-pocket maximum specific to children's dental care costs; therefore, the total out-of-pocket costs for a child's dental care accumulate to the health plan's out-of-pocket maximum limit.

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

The 2016 embedded dental plans are listed in the chart below.

chart

What Dentists Need to Know

Know your status: As reported previously, dental plans participating in Covered California have not established separate dental provider networks for the Covered California products they offer. However, dentists are encouraged to verify participation status with the dental plans in their area and confirm the reimbursement fee schedule for treating Covered California enrollees. Advise patients when scheduling whether you participate as a contracted provider with the patient's plan.

Avoid unwelcome surprises: Do some homework before the patient arrives for his or her visit by obtaining updated dental information at the time of scheduling and diligently verify the patient's eligibility and benefits.

New deductibles/copayments for the year: Many plan's calendar year deductibles and visit frequency limitations were reset. Additionally, some patient plans may have new copayment amounts. This reinforces the importance of checking patient eligibility and benefits before the patient arrives for their visit.

Dentists may contact CDA public affairs staff at 800.232.7645 for more information.



Related Items

The open enrollment period for health and dental coverage offered through Covered California, California's benefit marketplace created by the federal Affordable Care Act continues through Jan. 31. Since open enrollment began on Nov.1, more than 60,000 enrollees have selected dental coverage through Covered California's Family Dental Plans or California Covered for Small Business.

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.

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