Dental Plans

Dental coverage for adults is not considered 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.

While all health plans through Covered California include children's dental insurance at no extra cost, you can buy additional dental insurance for your kids in the form of a family dental plan. One reason to enroll children in a family dental plan is that your dental service provider may not be in the same network as 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.”

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.

There is no deductible and no annual limit on what the plan will pay for a member’s care for dental DHMO plans. 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.

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.

Adults in dental PPO plans have a six-month waiting period for major services. This waiting period can be waived if the member provides proof of prior dental coverage to the dental plan. For every month of prior coverage the consumer can verify, the waiting period is shortened by one month. Major services are subject to a $1,500 annual limit on what the plan will pay.