Future-Proofing Your Smile: Individual Dental Insurance is Changing Healthcare

Choosing the right dental plan can save you hundreds or thousands of dollars. The best plans have low or no premium costs and cover most dental work expenses.

Find the right Marketplace dental plan by answering a few simple questions. Then, enroll now.

What Is Dental Insurance?

Dental insurance covers some or all of the cost of a dental procedure. Dental plans can be purchased individually or as part of a larger health plan like medical insurance. Many employers offer group dental coverage that may be cheaper and more comprehensive than individual or family plans on the ACA marketplace or directly from an insurer.

Like health insurance, the dental coverage industry has established relationships with dentists and other oral care providers to form an insurance network. This allows them to negotiate with these professionals and provide coverage at lower rates. These discounted fees are known as the let charges. The difference between the allowable charge and the actual fee charged by a dentist is billed to the policyholder.

For instance, California individual dental insurance ensures residents have access to personalized oral healthcare coverage, offering various plans to suit individual needs and preferences.

Generally, most dental plans follow the 100-80-50 model: preventive services are covered at 100%, essential services at 80%, and major restorative procedures (like crowns) at 50%. In addition to a deductible, the policyholder is responsible for coinsurance, or the percentage of costs left after the insurance company covers its portion.

There are also indemnity dental plans, which allow the policyholder to visit any dentist and be reimbursed a set amount for each procedure — usually in the form of an annual maximum that can be reached with each course. These plans also typically have a deductible that the policyholder must pay out of pocket before the insurance starts to cover expenses.

HMO Plans

An HMO (health maintenance organization) is a health plan that has a list of doctors, medical groups, hospitals, and labs you can use to get your care. You must choose a primary care doctor from the plan’s list and get referrals from your PCP (primary care provider) before seeing a specialist. HMOs are regulated by California’s Department of Managed Health Care (DMHC). You can check the quality of HMO plans and providers using the DMHC’s HMO Report Card.

HMOs can also be combined with PPOs to create point-of-service (POS) plans. This type of plan allows you to see out-of-network providers but requires you to pay more if you do so. These projects are often used for vision and behavioural or mental health care.

PPO Plans

Preferred provider organization plans, or PPOs, are one type of health plan growing in popularity. While these plans tend to have higher premiums than HMOs, the added flexibility can be worth it for some people. With a PPO, you don’t need to choose a primary care physician and can see specialists without referrals if the specialist is in your health insurance network. However, you may be responsible for an annual deductible and a percentage of charges (coinsurance) before the plan starts to pay for services.

Several of the traditional California health insurance carriers that were primarily HMO-based made significant moves to PPO-type plans when HMOs came under fire because they wanted to offer consumers more choices while keeping costs lower. If you’re considering a PPO, check that your favourite doctors are part of your carrier’s network.

Some providers choose not to join networks for various reasons, including low reimbursement rates and strict protocols.

DeltaCare(r) USA

With DeltaCare USA plans, you and your family can choose your dentist from a network of participating dentists. A DeltaCare USA member can get the most primary dental services and be referred to a specialist through their selected general dentist for additional care. These managed care plans are offered and administered by Delta Dental Insurance Company.

Unlike PPO plans, DeltaCare USA does not have annual maximums or deductibles and no waiting periods. DeltaCare USA is available in most states, including:

As a managed care plan, like medical HMOs, DeltaCare USA requires you to visit a limited number of contracted dentists for all primary and secondary dental services. You can find the list of participating dentists on your DeltaCare USA membership card. If you choose a non-DeltaCare USA contract dentist, your DeltaCare USA plan will not pay for the service or will only pay a lower percentage of the fee. You can also get help from a DeltaCare customer service representative if you have questions about your DeltaCare USA plan. You can contact them by phone or online.