10/16/2017

Open enrollment for 2018 Covered California dental plans begins Nov. 1


Covered California, California’s health insurance marketplace for the federal Affordable Care Act, has released the participating dental plans for the 2018 benefit year.

Despite concerns about marketplace challenges, limited plan offerings and premium increases around the country, California’s marketplace remains stable and high-performing. Dental coverage uptake increased over 60 percent between 2016 and 2017, with the majority of enrollees selecting a dental health maintenance organization.

For 2018, all of Covered California participating dental plans adjusted their premiums, and some dental plans elected to shift their service areas of coverage for next year. However, the dental benefit packages did not change from 2017 to 2018.

Open enrollment for 2018 coverage begins Nov. 1 and ends Jan. 31, 2018. Both adults and children may enroll in Covered California’s individual and family plans as an optional benefit. There is no tax penalty for consumers who elect not to enroll in a family dental plan and no financial assistance (in the form of a tax credit or subsidy) is available for dental coverage.

There are two types of dental plan product types available for purchase, contingent on the location of the enrollee. These are a dental preferred provider option (DPPO) and a dental health maintenance organization (DHMO). CDA has continued to advocate for more than one product type for enrollee selection.

The 2018 individual/family and small-business dental plan offerings include the following:

Individual/Family Dental Plans:
Access Dental Plan - DHMO
Anthem Blue Cross - DPPO
California Dental Network - DHMO
Delta Dental of California - DHMO, DPPO
Dental Health Services - DHMO
Liberty Dental Plan - DHMO
Premier Access - DPPO

Covered California for Small Business:
California Dental Network - DHMO
Delta Dental of California - DHMO, DPPO
Dental Health Services - DHMO
Liberty Dental Plan - DHMO

The 2018 monthly dental plan premiums range from $7.47 to $45.58 for a DHMO product and $27.05 to $61.46 for a DPPO.

As dental coverage for children is an “essential health benefit” under the Affordable Care Act, all health plans purchased through Covered California include children’s dental coverage. Children under age 19 are automatically covered by dental benefits that are embedded in health plans purchased through Covered California. The chart offered here shows the corresponding dental plan that will provide benefits to the enrolled child when the enrollee selects a given health plan.

What dentists need to know

Confirm participation status: Dentists are encouraged to verify their participation status with the dental plans offered in their area (visit coveredca.com to view the plan offerings in your region) and confirm the reimbursement schedule for treating Covered California enrollees. Dentists should advise patients when scheduling appointments as to whether they participate as a contracted provider with the patient’s dental plan.

Avoid unwelcome surprises: Dental practices should obtain updated dental plan information from their patients at the time of scheduling and diligently verify the patient’s eligibility and benefits before the patient arrives for his or her visit.

New deductibles/copayments: Many plans’ deductibles and frequency limitations may reset at the beginning of the calendar year and patient copayment amounts may also shift, which reinforces the importance of verifying patient eligibility and benefits prior to the patient’s arrival for treatment.

CDA member dentists may contact TDIC Sales at 800.733.0633 for assistance with small-business health and dental plan purchasing. Dentists may also contact CDA Public Affairs staff for more information at 800.232.7645.



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The Department of Health Care Services on June 30 announced hundreds of procedure codes will receive a 40 percent supplemental rate increase as the result of Proposition 56, the tobacco tax measure sponsored and supported by CDA and approved by voters last November. Over $1 billion of the tobacco tax revenue is allocated to improved payments to physicians and dentists who treat Medi-Cal patients.

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