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.
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.
The dental benefits typically break down into three main areas.
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.
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