A quick guide to California
individual dental insurance
Typically the first question
after someone has chosen a
health insurance plan is "What
about dental?". Most
people looking at the
individual
insurance market in California
are coming off of
Small Group
coverage (directly or as a
dependent) and dental insurance
is usually part of most Group
benefit packages. It's
possible to add any of the
available dental plans to any of
the medical plans and some of
the newer plans on the market
such as
Tonik health insurance
from Blue Cross include a
limited dental benefit built in.
Let's take a quick look at how
dental insurance plans work for
individuals and families in
California.
HMO, PPO, or Indemnity dental
insurance
This
really
is the
first
question
to ask.
Let's
walk
through
the
three
different
types of
dental
insurances
first.
HMO
means
that you
choose a
primary
dentist
or
dental
group up
front
and your
services
are
handled
solely
by this
provider
or
through
referral
to
select
specialists
in a
defined
group.
Essentially,
you have
less
choice
of which
dentist
you can
use and
the
providers
tend to
be more
dental
hygiene
groups
when you
get your
basis
services
done.
The
trade
off is
that the
premium
is very
inexpensive
and
there
can be
no cap
on the
amount
the
carrier
will pay in
a year's
time.
HMO
plans
run
about
$10-30
per
person
on a
monthly
basis in
the
California
individual
market.
PPO
means
that you
have
larger
list of
dentist
which
you can
use for
lower
out-of-pocket
expense
to you.
You can
go off
the list
but you
will pay
more if
you do
so.
PPO
plans
offer
more
flexibility
and a
wider
choice
of
dentists
but they
are also
more
expensive
in terms
of
monthly
premium.
You will
also
share
more of
the
expense
(usually
coinsurance
percentage
or
copay)
than
with an
HMO and
there is
typically
a cap of
$1000-2,000
dollars
per year
after
which,
the
carrier
will no
longer
pay
benefits.
This cap
is a
significant
difference
between
PPO
and HMO
plans
especially
if you
have
larger
dental
bills in
a year.
PPO
plans
run
about
$25-50
per
person
on a
monthly
basis.
Indemnity
means
that you
have no
network
and the
plan
will pay
out
benefits
(similar
to PPO
benefits)
the same
for all
providers.
Indemnity
plans
tend to
be more
expensive
but they
work
well if
your
dentist
does not
participate
in any
networks
(which
is more
common
these
days).
The
major
health
carriers
have
moved
away
from
Indemnity
dental
plans
just as
they
have
medical.
There
are some
smaller
carriers
that
still
offer
Indemnity
dental
benefits.
Indemnity
plans
run
about
$40-60
per
person
on a
monthly
basis.
What do
dental
insurance
plans
cover?
The
dental
benefits
typically
break
down
into
three
main
areas.
1)
Preventative.
This
typically
includes
cleanings
and
x-rays.
The
dental
plans
will
usually
cover
these
services
at 100%
when
in-network.
Sometimes
there
may be a
small copay.
You can
expect
to pay
more for
out of
network
providers
with a
PPO.
With HMO
dental
plans,
you will
have to
stay in
the
network
in order
to have
any
coverage.
2) Minor
Dental
services.
This
typically
includes
fillings
and
extractions
etc.
As a
rule of
thumb,
dental
plans on
the
individual
market
will pay
about
60-70%
of these
services
(in-network).
There
may be
smaller
waiting
periods
for such
services
of 3-6
months
depending
on the
plan.
This
means
that you
need to
be on a
dental
plan for
a period
of time
before
they
will
cover
such
services.
3.
Major
Dental
services.
This
typically
includes
services
such as
root
canals
and root planing
etc.
Generally
speaking,
dental
plans
will pay
around
50% of
these
services
(in-network).
There
are
typically
waiting
periods
(especially
for PPO
and
Indemnity
plans)
of 12
months
on
average.
Between
the
network
differences
(HMO,
PPO, or
Indemnity)
and the
three
general
categories
of
services
provided
by
California
dental
insurance
plans,
you have
a good
understanding
of the
various
options
on the
market.
Other
important
concepts
to help
you
understand
your
California
dental
insurance
quote
are:
Individual
health
insurance
underwriting
The
concept
of
health
insurance
Understanding
health
insurance
costs