Sole Focus on Your Smile: The Importance of Individual Dental Plans in California

Individual dental insurance plans aren’t just for those without health coverage. Often, people looking into purchasing personal medical or dental insurance are coming off Small Group health coverage (either directly as an employee or as a dependent).

There are a variety of plans to choose from. These include dental PPOs, DHMOs, indemnity plans, and discount dental programs.

Choosing the Right Dentist

Unlike medical insurance, which is designed to cover the cost of care regardless of where you get it, dental plans typically have dentist networks that determine who receives coverage. You want to choose a project with the right network size so that you and your family can visit a dentist who can provide the necessary treatments without incurring extra out-of-pocket costs.

Individual dental plans can be health maintenance organizations (HMOs), preferred provider organizations (PPOs), or indemnity plans. All have different monthly or annual premium costs, typical coverage, and freedoms regarding which dentist you can visit. For example, DHMO dental plans are often the most affordable option but require selecting an approved dentist upfront. DHMOs may also need a referral from your primary care physician for specialist dental care.

In contrast, PPO dental plans offer a more comprehensive selection of providers and tend to have higher monthly premiums than DHMOs. They are available through Covered California and can be paired with most medical plans. Some dental insurance plans also include vision coverage.

In-Office Visits

In addition to annual deductibles, individual dental plans in California often include other cost-sharing provisions like copayments and coinsurance. Typically, a copayment is a fixed dollar amount the plan member pays each time they see their dentist. Most dental plans also have a yearly maximum, which is the most that the insurance will pay in a year for any given service.

The types of individual dental plans available in California vary by carrier but include dental health maintenance organizations (DHMOs), preferred provider organization plans (PPOs or DPPOs), indemnity insurance plans, and discount dental programs. HMO plans to limit the selection of providers to a specific network and generally offer lower monthly premiums than PPO plans.

Preventive Care

Individual dental plans may cost more than group policies, but they often offer a higher level of coverage. They can help insured parties receive preventive care, such as cleanings and X-rays, to prevent or treat problems before they worsen. In addition, they can cover some major procedures, like crowns and root canals.

However, when choosing one, it’s essential to consider a plan’s deductible and annual maximum. These limits determine how much the policy will pay for a person’s dental care each year. Indemnity plans tend to have lower deductibles, but they may also have higher premiums. Dental Preferred Provider Organization (PPO) and Health Maintenance Organization (HMO) plans generally have lower deductibles. Still, they require a person to visit dentists in the plan’s network for lower costs.

Individuals can purchase dental insurance as part of a health care exchange plan or on a stand-alone basis. Plans purchased through the exchange typically have a lower monthly premium and less expensive deductibles than those bought independently. They may also have a higher maximum benefit. Individuals can also purchase discount dental plans, which work more like warehouse club memberships and offer straightforward savings without traditional insurance complexities.

Restorative Care

Individual dental plans are available to those who don’t have group insurance or who are coming off small group coverage. They come in three categories: HMO, Preferred Provider Organization, and Dental Discount Plans. HMOs require you to choose a primary dentist and have more restrictions on where to go for essential services. Preferred Provider Organizations typically offer a wider choice of providers and tend to be more expensive. Dental discount plans, also called “fee-for-service” plans, are less costly than HMOs and PPOs but usually don’t cover anything beyond a usual and customary amount set by the American Dental Association.

Most Medicare Advantage plans have annual dollar limits on how much they will pay toward a given procedure or restorative care, except for two projects with no caps. Before deciding on one, you must familiarize yourself with your plan’s limitations and cost approximations.

Emergency Care

Since dental care isn’t among the ten essential health benefits under the ACA, many insurance companies view it as supplemental to medical coverage. 

Most insurance plans include copays, a flat dollar amount you pay for services, and a deductible, the total amount you must spend out of pocket before your project starts paying. In contrast, dental plans with Preferred Provider Organization (PPO) networks offer reduced fees for enrollees that are typically cheaper than indemnity or fee-for-service dental plans.

Most individual plans sold on the marketplaces and through small business plans include pediatric dental benefits. However, adult plans are sometimes offered stand-alone and may feature richer benefits. However, it’s essential to consider whether a separate dental plan makes sense for your needs. A dental plan can save you money on preventative care and help you pay for needed procedures when your medical coverage isn’t available or insufficient.

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