For those who are employees at California companies that offer health insurance, their dental coverage is often included as an option.
However, many others must acquire a California dental insurance plan for themselves or their families on their own.
In addition to a healthy diet and plenty of exercise, maintaining proper dental hygiene and care is a major contributor to good health and well-being. In fact, many dental conditions are preventable. However, more is often required than simply brushing and flossing alone. We understand that regular dental visits support good oral care.
Regular visits to the dentist encourage early diagnosis and treatment of problems without extensive testing or elaborate and expensive procedures. Research shows that gum disease may be a leading cause of heart disease over cholesterol, hypertension, smoking, age, and gender. Maintaining preventive dental health will lessen your chances for heart disease and major dental expenses.
And dental insurance will help minimize the cost of needed services.
As we’ve noted elsewhere,
“Whether you acquire dental coverage to protect your children from tooth decay or the adults in your family from chronic conditions, a dental plan will minimize expenses. In addition, having a California dental insurance plan can help reduce other healthcare costs as you age.”
3 Types of California Dental Insurance Plans
While there are as many as eight different types of insurance plan schemes, according to the American Dental Association (ADA), there are essentially three plan types offered in California:
1. Dental Health Maintenance Organization
DHMO, or Dental Health Maintenance Organization, plans tend to be the most affordable dental insurance plans for many people.
While there is no annual maximum spending limit and no waiting periods with DHMO plans, they often have limitations such as your choice of a primary dentist for your care and referrals for specialists, all within the network, along with limits for treatment frequency.
2. Dental Participating Provider Organization
DPPO, or Dental Participating Provider Organization. Similar to medical PPOs, these plans are among the most widely accepted plans in California. Although members also save money with in-network dentists, unlike a DMHO plan, they can also go out-of-network for dental service. In addition, referrals are not required to see a specialist.
Typically, with DPPO plans, a six to twelve-month waiting period is required before receiving any dental treatment aside from basic, preventive care. In addition, the maximum spending limits are usually between $1000 to $1500.
3. Dental Indemnity Insurance Plans
Dental Indemnity Insurance Plans, also known as traditional plans, are not as common in California. They are also the most expensive type of dental insurance. The overall structure of Dental Indemnity plans is similar to a DPPO plan, but with annual maximum spending limits between $2,500 to $3,500 or more. In addition, there are some waiting periods required.
Essentially, a Dental Indemnity Insurance plan is a member reimbursement plan. This approach requires plan members to pay their dental providers out-of-pocket, who are then reimbursed by the insurance company afterwards. Some plans also require a waiting period for restorative care such as crowns or implants.
What To Know About California Dental Insurance Plans
The most widely accepted California dental insurance plans include waiting periods and annual benefit maximums to reduce their monthly cost.
Preferred Provider Organization (PPO) plans typically have a three to six-month waiting period for basic services (fillings) and a twelve-month wait for major services (root canals, oral surgery, crowns, etc.). Typical benefit maximums range from $500 to $2,000 annually.
The flip side to a PPO policy is a Health Maintenance Organization (HMO) plan which typically does not include waiting periods or annual benefit maximums but has a more limited network of providers. While the network of dentists is smaller, you get a real boost in benefits.
Potentially you can receive coverage for fillings, root canals, crowns, and oral surgery on the policy effective date and not have to worry about benefit maximums. If you don’t mind switching dentists and have a need for a California dental insurance plan to assist with costs, an HMO plan is recommended.
Keep in mind you must apply for California dental insurance plans no later than the 20th of the month prior to your effective date. Applications received after 3:00 PM on the 20th will automatically be effective the first of the following month.
J. C. Lewis Is Your Local Resource Your Dental Insurance Needs
JC Lewis Insurance Services has been helping individuals, families, and employers obtain health and dental insurance in California since 1979.
With three generations of the Lewis family, we are a family-owned and operated California health insurance agency, providing personalized service that is second to none.
And our team of expert brokers offer individual and family dental insurance plans.
In addition, we provide small business and individual health insurance plans from only the leading health insurance carriers that are licensed to do business in California.
In addition to being experienced, professional brokers, we are licensed and certified by each of these insurance carriers to offer coverage to individuals, families, and small group employers in addition to Medicare supplemental and prescription drug plans for seniors.
When you’re looking to obtain a dental insurance plan for yourself or your family, you will likely have several questions and concerns.
At J. C. Lewis Insurance Services we welcome your questions about insurance coverage and you can be confident that we will help you find the right solution.