The time to enroll in a dental plan is not when you need a filling, crown, or root canal. Unlike health insurance, there are waiting periods for most individual and family dental plans before the plan will share in the cost of the dental services. Consequently, the time to enroll in a dental plan is before you need high cost dental services.
In general, most dental plans will cover cleanings, exams, and x-rays at 80 to 100 percent on day one of enrollment. What drives the dental insurance rates beyond the basic diagnostic and preventive services are the waiting periods for minor and major restorative dental procedures and how much the dental plan will pay on the member’s behalf in a given year.
Delta Dental California PPO Plans
A good example of the pricing components is found in the 2020 Delta Dental PPO individual and family plans. Delta Dental has a Basic plan for about $30 per month or a Premium plan for $65 per month per adult. (Children have lower rates in each plan category.) Both the Basic and Premium plans have $50 deductible and cover exams, cleanings, x-rays, and sealants at 100%. They both have a 6-month waiting period before the plan shares in the cost of minor restorative procedures such as fillings or simple extractions.
A significant difference between the two plans is that the Basic plan has no coverage for major restorative services such as root canals, bridges, implants, crowns, or orthodontia. The Basic plan will only cover 50 percent of the cost of basic services – after the 6-month waiting period – while Premium plan pays 80 percent. The other difference accounting for the lower rate of the Basic plan is the maximum member benefit is $1,000. The Premium plan will pay up to $1,500 per member.
The Premium plan is fairly comprehensive covering all of the minor and major dental services that are normally encountered. In addition, it also has limited coverage for teeth whitening, mouth-guards, orthodontics, and dental implants. The major services are covered at 50 percent after the 6-month waiting period. The 6-month waiting period is better than some plans that have a 12-month waiting period, but it also adds to the cost of the Premium plan.
Orthodontia is another element that drives up the cost of the Premium plan. There are other plans that don’t include orthodontics and have a lower monthly rate. Dental implant coverage is becoming standard in many plans as this service has become more popular over bridges. The downside is that dental implants are very expensive and a $1,500 maximum annual benefit will only partially cover the cost of one dental implant.
The Delta Dental PPO Premium plan closely mirrors the Delta Dental product offered to consumers in Covered California. The significant differences are that the Covered California PPO plans do not cover orthodontia or dental implants. The Delta Dental PPO plan through Covered California are $12 to $15 less per month. However, you can only purchase the Covered California Delta Dental PPO plans if you are enrolled in a Covered California health plan.
Even if you visit a non-participating dentist with Delta Dental PPO plan (out of network), Delta Dental will still pay their portion according to their contracted rate schedule. For those individuals truly looking for the basics, the Delta Dental HMO Delta Care plan may be suitable. For adults, the monthly rate for the Delta Dental HMO plan is about $9 per month.
Delta Dental California HMO Plans
As opposed to a coinsurance percentage of coverage for dental services, HMO plans have a fee schedule. After a $5 cleaning copayment, the exams and x-rays are $0. All of the other dental procedures have a set fee or copayment amount. For example, a resin (tooth colored) filling will be $35 and a porcelain crown is $300. There is no coverage for implants, but dentures, orthodontics and teeth whitening are included.
The biggest challenge, especially for residents in rural areas, is finding a dentist who accepts any HMO dental plans. Residents in suburban and urban areas are more likely to find more participating dentists. But if all you want are the twice-yearly cleanings, exams, and x-rays, then an HMO plan, with its modest monthly cost, might fit your requirements.
This content was originally published here.