California, as the most populous state in the U.S., supports a robust dental insurance market with many options. The upside of this situation is the wide variety of benefit designs, dentist networks, and price points offered to California residents. The downside of the wealth of plan alternatives is the complexity of the shopping experience. However, this article will help you compare your options better by:
A 2021 review of 39 dental plans in California found the lowest available premium for an individual was $6.95 a month (Dental Health Services’ SmartSmile DHMO) and the highest was $85.44 (Delta Dental's Immediate Coverage Plan PPO). Across all dental plans examined, the average monthly premium was $39.30. With respect to deductibles (i.e. the amount you pay out of pocket before the plan starts sharing costs), the smallest was $0 (held by several plans) and the most expensive was $150. Family deductibles are normally higher than individual deductibles just as family premiums are higher than individual premiums. The 10 insurers offering the 39 plans examined were:
This group represents a subset of all the insurers within the state. On California’s Department of Insurance website, we found 54 corporate entities submitting Medical Loss Ratio information on California dental plans.
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 that variation does not neatly line up with each plan’s price. For example, 87 percent of the plans analyzed had a maximum benefit value that the plan would pay annually toward an enrollee’s dental cost. The lowest amount was $500 and the highest was $3,000. However, when reviewing plans, we found plans that ranked in the top 15 percent with respect to the highest premiums but they had a $1,500 threshold on annual benefits, which was only 50% of the highest maximum benefit offered ($3,000). Several DHMO plans had no maximum benefit but these plans have very restrictive dentist networks.
While some dental plans have no waiting periods before more expensive dental services will be covered, the most expensive plan examined had a waiting period of 12 months for orthodontic services but none for preventive care, basic care, and major dental care. There were several other expensive plans that still had a six-month waiting period for basic care and 12-18 month waiting period for major care.
Monetary limits on benefits and waiting periods can all affect the value of a dental benefit so that, for example, crown coverage in one dental plan may be more meaningful than in another where there is a low maximum benefit and a long waiting period before a crown may be obtained under insurance coverage.
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 network of dentists who accept the 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 (DHMO), preferred provider organizations (DPPO), indemnity plans, or discount programs. PPOs typically have wider networks of dentists than DHMOs but may have higher out-of-pocket costs. Additionally, a DHMO 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 DHMOs.
Indemnity plans warrant a mention as well as discount programs. An indemnity 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 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.
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 resource lists free and low cost dental services available in California, including free dental clinics, sliding fee scale dental clinics, and non profit dental clinics.
Eureka! (I found it!)
Increasing benefits after the first and second years. Keep your dental plan regardless of
Plan Type: PPO
Plan Maximum: $1000
Use one of our 115,000 network providers to get the most from this plan. No waiting periods.
Plan Type: PPO
Plan Maximum: $2000
Immediate coverage with no waiting periods for most services. Generous plan maximum.
Plan Type: PPO
Plan Maximum: $3000