Dental Plans

Covered California’s family dental plans are available to adults (single or married) and children. 

The participating dental carriers are Access Dental Plan, Anthem Blue Cross, California Dental Network, Delta Dental of California, Dental Health Services, Liberty Dental Plan and Premier Access.

Dental coverage for adults is not an essential health benefit, so dental coverage for adults is offered separately from health insurance plans. No financial assistance is available to purchase these dental plans. There is no maximum out-of-pocket limit for enrolled adults.

Family dental plans may offer a wider range of dental service providers than what is offered through the dental coverage included with the child’s health plan. When children are insured by both a health plan and a family dental plan, the two plans will “coordinate benefits.”

Purchase Requirements

Family dental plans are only available to those who have purchased a health plan through Covered California.

There must be at least one adult (age 19 or older) enrolled in a family dental plan in order for a child in the family to enroll. (Not all adults in the household are required to enroll.) If a family chooses to enroll children in a family dental plan, all children younger than 19 who live in the household must enroll.

Family Dental Plan Details

Covered California offers two types of dental plans: HMO (health maintenance organization) plans and PPO (preferred provider organization) plans.

Preventive, diagnostic and treatment services are covered at no cost for both adults and children. Family dental plans include an out-of-pocket maximum of $350 per child per year and $700 per family if more than one child is enrolled.

Refer to the plan’s policy or its “Evidence of Coverage” for a complete list of covered services provided and any exclusions and limitations on those services.

Dental HMO Plans

There is no deductible and no annual limit on what the plan will pay for a member’s care. The costs for fillings, root canals, crowns and other major treatments and services are shared by the consumer and the plan, according to a defined set of copays for services. Costs for dental work performed by dental providers outside the plan’s network are not covered.

Premiums are typically lower for dental HMO plans than for dental PPO plans.

Dental HMO: What the Member Pays

 
Types of ServiceChildAdult
Diagnostic and preventive (includes X-rays, exams, cleaning, sealants)
 
Child
$0
 
Adult
$0
Not subject to a deductible
Amalgam filling – one surface
 
Child
$25
 
Adult
$25
Not subject to a deductible
Root canal – molar
 
Child
$300
 
Adult
$300
Not subject to a deductible
Gingivectomy per tooth
 
Child
$50
 
Adult
$50
Not subject to a deductible
Extraction – single tooth, exposed root or erupted
 
Child
$65
 
Adult
$65
Not subject to a deductible
Extraction – complete bony
 
Child
$160
 
Adult
$160
Not subject to a deductible
Crown – porcelain with metal
 
Child
$300
 
Adult
$300
Not subject to a deductible
Medically necessary orthodontia
 
Child
$350
 
Adult
not covered
Not subject to a deductible
Not subject to a deductible

 

Dental HMO Plan Details

Plan DetailsChildAdult
Deductible (waived for diagnostic and preventive)
 
Child
$0
 
Adult
$0
Annual benefit limit
 
Child
none
 
Adult
none
Individual out-of-pocket maximum
 
Child
$350
 
Adult
N/A
Family out-of-pocket maximum
(two or more children)
 
Child
$700
 
Adult
N/A
Office copay
 
Child
$0
 
Adult
$0
Waiting Period
 
Child
none
 
Adult
none

 

Dental PPO Plans

There is a $50 deductible for each enrolled adult. The costs for fillings, root canals, crowns and other major treatments and services are shared by the consumer and the dental plan using a set percentage (e.g., 20 percent for a filling or 50 percent for a root canal). Some costs for dental work performed by dental providers outside the plan’s network are covered, and there may be greater choice in dental service providers.

It is important to note that benefits for adults in the dental PPO plans can include a six-month waiting period for major services and are subject to a $1,500 annual limit on what the plan will pay.

 

Dental PPO: What the Member Pays

 
Types of ServiceChildAdult
In-NetworkOut-of-NetworkIn-NetworkOut-of-Network
Diagnostic and preventive
(includes X-rays, exams, cleanings and sealants)
Child In-Network
0%
 
Child Out-of-Network
10%
 
Adult In-Network
0%
 
Adult Out-of-Network
10%
Not subject to a deductible
Amalgam filling — one surface
Child In-Network
20%
 
Child Out-of-Network
30%
 
Adult In-Network
20%
 
Adult Out-of-Network
30%
Root canal — molar
Child In-Network
50%
 
Child Out-of-Network
50%
 
Adult In-Network
50%
 
Adult Out-of-Network
50%
Gingivectomy per quad
Child In-Network
50%
 
Child Out-of-Network
50%
 
Adult In-Network
50%
 
Adult Out-of-Network
50%
Extraction — single tooth, exposed root or erupted
Child In-Network
50%
 
Child Out-of-Network
50%
 
Adult In-Network
50%
 
Adult Out-of-Network
50%
Extraction — complete bony
Child In-Network
50%
 
Child Out-of-Network
50%
 
Adult In-Network
50%
 
Adult Out-of-Network
50%
Crown — porcelain with metal
Child In-Network
50%
 
Child Out-of-Network
50%
 
Adult In-Network
50%
 
Adult Out-of-Network
50%
Medically necessary orthodontia
Child In-Network
50%
 
Child Out-of-Network
50%
 
Adult In-Network
not covered
 
Adult Out-of-Network
not covered
Not subject to a deductible
 

Dental PPO Plan Details

 
Plan DetailsChildAdult
In-NetworkOut-of-NetworkIn-NetworkOut-of-Network
Deductible (waived for diagnostic and preventive)
Child In-Network
$75
 
Child Out-of-Network
$75
 
Adult In-Network
$50
 
Adult Out-of-Network
$50
Annual benefit limit
Child
none
 
Adult
$1,500
Individual out-of-pocket maximum
Child In-Network
$350
 
Child Out-of-Network
N/A
 
Adult
N/A
Family out-of-pocket maximum
(two or more children)
Child In-Network
$700
 
Child Out-of-Network
N/A
 
Adult
N/A
Office copay
Child In-Network
$0
 
Child Out-of-Network
$0
 
Adult In-Network
$0
 
Adult Out-of-Network
$0
*Waiting Period
Child In-Network
none
 
Adult Out-of-Network
none
 
Child In-Network
6 months for major services
 
Adult Out-of-Network
6 months for major services
Not subject to a deductible. *Waived with proof of prior coverage; proof of prior coverage requirements may vary by plan.
 

Related Links

Dental Coverage
Children’s Dental
Glossary