Family Dental Plans

Covered California’s family dental plans make benefits available to both adults (single adults and married adults) and children. Enrollment in these plans is optional, and there is no tax penalty if you do not enroll in an optional family dental plan. There is no financial assistance available to purchase family dental plans.

The participating dental carriers are:

  • Access Dental Plan
  • Anthem Blue Cross
  • California Dental Network
  • Delta Dental of California
  • Dental Health Services
  • Liberty Dental Plan
  • Premier Access

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. (All adults in the household are not required to enroll.) If a family chooses to enroll children (younger than 19) in a family dental plan, all children younger than 19 who live in the household must enroll.

Family Dental Plan Details You Need to Know

  • Preventive and diagnostic services are covered at no cost for both adults and children.
  • Basic and major treatment services are covered for both adults and children.
  • There is no maximum out-of-pocket limit for enrolled adults, because adult dental benefits are not essential health benefits.
  • There are two types of family dental plans: dental health maintenance organization (DHMO) plans and dental preferred provider organization (DPPO) plans. See below for specific information for each.

Family Dental HMO Specifics

  • There is no deductible.
  • There is 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 copayments for services. (Check the details of each family dental plan’s schedule of benefits for more information.)
  • Costs for dental work performed by dental providers outside the plan’s network are not covered.
  • Premiums are typically lower for DHMO plans than for DPPO plans.
  • Many services are plan-specific and must be researched individually. When shopping for a dental plan, check the plan’s “evidence of coverage” or “certificate of insurance” documents for detailed information on benefits. Some member costs for common treatments and services are below:
ENROLEE PAYS - DHMO
Benefits in blue not subject to a deductible
Types of Service Child Adult
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
PLAN DETAILS - DHMO
Plan Details Child Adult
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

The listed services and the associated cost-sharing amounts represent a summary of services the plan provides. Please refer to the plan’s Policy or Evidence of Coverage for a complete list of covered services provided and any exclusions and limitations on those services.

Family Dental PPO Specifics

  • 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’s important to note that benefits for adults in the DPPO 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.
  • Many services are plan-specific and must be researched individually. When shopping for a dental plan, check the plan’s “evidence of coverage” or “certificate of insurance” documents for detailed information on benefits. Some member costs for common treatments and services are below:
ENROLEE PAYS - DPPO
Benefits in blue not subject to a deductible
Types of Service Child Adult
In-Network Out-of-Network In-Network Out-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
PLAN DETAILS - DPPO
Plan Details Child Adult
In-Network Out-of-Network In-Network Out-of-Network
Deductible (waived for diagnostic and preventive)
Child In-Network
$65
Child Out-of-Network
$65
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

The listed services and the associated cost-sharing amounts represent a summary of services the plan provides. Please refer to the plan’s Policy or Evidence of Coverage for a complete list of covered services provided and any exclusions and limitations on those services.

*Waived with proof of prior coverage; proof of prior coverage requirements may vary by plan.

What to Consider When Deciding if a Family Dental Plan Is Right for Your 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.

Family dental plans may offer a wider range of dental service providers, including dentists who may not be available through your child’s embedded dental coverage (the dental coverage included with their health plan).

When your children are insured by both a health plan and a family dental plan, the two will “coordinate benefits.” It is important to review the plans’ “evidence of coverage” and “certificate of insurance” documents for detailed information before enrolling children in a family dental plan.

Financial Assistance

Financial assistance is not available for family dental plans. The tax credit (premium assistance) available to some consumers to help them pay for their health insurance cannot be used for the purchase of family dental plan coverage. Similarly, there are no enhanced dental plans, with reduced member cost sharing. There is also no tax penalty if you do not enroll in an optional family dental plan.