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At Thomas and Thomas, 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. Let's take a quick look at how dental insurance plans work for individuals and families in California.

health & Dental
HMO, PPO, or Indemnity dental insurance

This really is the first question to ask.

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.

For more information on this and your other insurance needs, please Contact Us

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