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California, as the most populous state in the U.S., supports a robust dental insurance market. The upside of this situation is the wide variety of benefit designs, dentist networks, and price points. The downside of the breadth of plan alternatives is the complexity of finding the right plan for your circumstances. Thankfully, this article will help you improve your insurance shopping by:
Price quotes for dental insurance are affected by several factors. First and foremost, how many people will be covered by the plan. Is the policy for an individual, a married couple, or a family with several children or dependents. Second, the same plan may be priced different in different areas because of regional differences in the cost of care.
This year's DentalInsurance.com review of the California dental market examined 43 dental plans sold in the state. The lowest available premium (note - prices varied on state region) among the 43 options was $6.95 a month (Dental Health Services' SmartSmile DHMO) for an individual enrollee. A close second in price was the MetLife TakeAlong Dental HMO-Managed Care 350 (Low) at $7.50. The most expensive monthly premium was $98.38 for Renaissance's Max Choice Plus. Nationwide Classic 2000 + VSP Premium, a plan that combined dental benefits with vision coverage was in the same price range at $93.65. For $85.44 a month, Delta Dental's Immediate Coverage Plan PPO offered broad coverage with no waiting periods. This plan also included orthodontic coverage, which is uncommon among dental plans.
Across the 43 dental plans examined, the average monthly premium was $47.61. California’s average for 2021 was $39.30, however, the 2021 study had fewer plans within the study. The 12 insurers offering the 43 plans examined were:
This group represents a subset of all the insurers within the state. On California's Department of Insurance website, we found 55 corporate entities submitting Medical Loss Ratio information on California dental plans.
While we always recommend shopping on a combination of benefits, dentists, and premium, some consumers just want to know what the cheapest dental plans are. In our California study, we found seven plans offered in various parts of the state that were under $20 a month in premiums (hough premiums can vary by region):
Depending on the insurer, premiums may vary by region, number of enrollees, and other factors. A higher premium does not necessarily mean superior insurance coverage. Benefits vary significantly from one plan to another and this variation does not neatly align with each plan's price. For example, 88 percent of the plans analyzed had a limit on how much the plan would pay annually toward an enrollee's dental costs (this limit is called the “maximum benefit”). The lowest maximum benefit was $500 and the highest was $5,000 (NCD Nationwide 5000 Plan). It is important to note that three different plans were more expensive than the NCD Nationwide 5000 Plan but had maximum benefit limits thousands of dollars less. The average maximum benefit in the study was $1,597. Some plans had maximum benefits that increased in the second and third year of continuous enrollment. The average only considered the first year of enrollment for a consumer. 12 plans in the study had a maximum benefit higher than the state average and an additional 5 plans had no maximum benefit limits. The plans without the maximum benefit limits were HMO dental plans and one dental discount program (Careington 500 Series Dental Savings, which cost less than $10 a month).
16 of the plans (37 percent) had no waiting periods on any of the covered services. A waiting period is a delay between the time an insurance plan becomes active and the date when a specific service will be paid for by the plan. Waiting periods are often placed on high-cost services such as crowns and root canals. Waiting periods are often as short as 90 days or as long as a year.
Out-of-pocket costs vary greatly for the same service. While the average portion of a cavity filling fee covered by a California dental plan was 61 percent, there were plans whose coverage was as low as 20 percent and others with coverage as high as 80 percent. More than half of the plans (63 percent) covered annual teeth cleaning with no out-of-pocket costs for the enrollee. For a simple tooth extraction, insurers covered 46 percent of the cost on average.
With respect to plans that included coverage of major dental services, the average insurance contribution for a crown was 33 percent in the first year of coverage (with some plans increasing contributions in subsequent years of continuous enrollment. This average contribution percentage was the same for a root canal. HMO dental plans typically charged a flat copayment for a crown ($383 average among HMOs). Crown coverage is a critical issue for consumers with cracked or weakened teeth. Crowns are among the most costly dental procedures. The average price of a crown ranges from $800 to $1,700 according to WebMD.
Deductibles were modest. On average, a single enrollee faced a $49 annual deductible. One-in-five plans (21 percent) had no deductible for enrollees. The highest deductible for an individual was $150 per year, but this deductible was paid only once for the entire time you remained enrolled in the plan. Some plans with orthodontic coverage had a separate deductible for those services. Families with multiple enrollees on the same dental plan may have a deductible per enrollee (e.g. $50 annually) or may have a maximum limit for the family deductible (e.g. $300 annually) regardless of the number of family members on the plan. One -in-three plans (37 percent) had a maximum family deductible of $150 per year.
The differences in benefits among dental plans makes detailed shopping extremely important. California passed a law in 2018 (The Dental Plan Transparency Act) that requires 2021 dental plans to provide a standardized benefit form for their plans that allow consumers to review the plan’s:
According to data published by Statista, California has more active dentists than any other state. Over 30,000 dentists practice in California. A dental plan's coverage is a critical aspect of dental insurance value. You should always check to see if your dentist is in-network prior to completing a dental insurance application so that you can reduce your risk of higher out-of-pocket costs. Services received from an out-of-network dentist can result in higher dental care bills and no payment assistance from your dental plan.
Plans may be health maintenance organizations (known as HMOs or DHMOs), preferred provider organizations (PPOs or DPPOs), indemnity plans, or discount dental programs. PPO dental plans typically have wider networks of dentists than HMO dental plans but may have higher out-of-pocket costs. Additionally, a HMO may not have a limit on annual benefits but, along with restrictive networks, they also require your dentist to provide a referral to an in-network provider when specialist care is required. 72 percent of the California plans examined were preferred provider organizations. Only one was a discount program and 13 percent were indemnity plans. The remainder were HMOs.
Indemnity dental plans warrant a mention as well as discount programs. An indemnity dental plan allows a person to use any dentist of his or her choice. However, the enrollee pays upfront for the dental service and then the indemnity plan will send a fixed reimbursement back to the enrollee for the care. The difference between the cost of care versus an indemnity plan's reimbursement can be significant. Additionally, not all dental services may be covered by an indemnity plan.
A dental discount program, in contrast, charges a monthly fee to enrollees and then the enrollees receive a discount on the standard price of dental care from participating dentists. These programs normally do not have a limit on annual benefits but the level of discount may still leave considerable costs to be covered by the enrollee.
COVID Requirements
Private dental insurance does not have an annual enrollment period. You can enroll in coverage any time of year. You can also change plans or discontinue coverage during the year. Group dental plans, offered by employers, normally have an annual enrollment period and won’t let you apply for coverage outside that time unless you qualify for a Special Enrollment Period (e.g. you were recently hired, you had a childbirth or adopted a child, you recently married, etc.).
Enrollment in a dental plan is easy. Go to the top of the page and click the button labeled “Get Price Quotes”. The button will bring you to a page where you can specify how many people need to be covered by the plan (e.g. you alone, you and family members). The page also asks for your zip code so it can filter out plans not available for your region.
When the plans are displayed, click the Apply Now button on the plan best suited to your needs. At this point, the application form starts and you can complete the form in a minute or two. After you submit your plan, you will receive an email notification confirming your enrollment.
Increasing benefits after the first and second years. Keep your dental plan regardless of
age.
Plan Type: PPO
Plan Maximum: $1000
Use one of our 115,000 network providers to get the most from this plan. No waiting periods.
Increasing benefits.
Plan Type: PPO
Plan Maximum: $2000
Immediate coverage with no waiting periods for most services. Generous plan maximum.
Plan Type: PPO
Plan Maximum: $3000
A study performed by the L.A. County Department of Public Health found that 59 percent of Los Angeles residents visited a dentist in 2015. Given the size of the city's population, this means approximately three million residents didn't see a dentist. Another unfortunate city trend identified by the study was that less than half the people earning below 200 percent of the Federal Poverty Level had visited a dentist in the past year (45 percent).
With the information provided in this study, you can compare your local rates to larger state trends. The following link will get dental insurance quotes for plans available in your zip code. You can also review the plans below, which are the bestselling plans for DentalInsurance.com in the State of California.
Over the past 150 years, CDA has grown to become the single largest chapter of the American Dental Association and a trusted resource for California dentists and their patients.
This page at the CDA site provides answers to questions about dental benefit plans, issues affecting seniors or those with special needs, and information about low-cost or free dental services.
This online resource lists a variety of free and low-cost dental providers grouped by county.
Medi-Cal, the Medicaid program for the state of California, covers dental services among its variety of medical benefits. Medi-Cal Dental is also known in California as Denti-Cal.
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