Where do we find better dental coverage? It’s a common question people ask when they’re looking into kids dental insurance options in California.
Finding ways to pay for kids’ dental appointments from the eruption of their first baby teeth is a legitimate concern. There’s no doubt that the whole process is confusing; where to start is the real question.
Here’s the good news —
The California Department of Health Care Services partners with Covered California to reduce health care costs. They offer government assistance for low-income individuals and families who qualify.
You’ll get better dental coverage for children through the Covered California dental plan. Not to mention, you’ll access premium coverage at a fraction of the cost because it’s all set up on a sliding fee scale.
But that’s not all:
The income limits for assistance are higher than you might imagine.
Businesses, individuals, and families who purchase their insurance on the open market get discounts through Covered California as well.
The California Health Exchange
You have the same choice of providers through Covered California whether you’re low-income and looking for dental coverage for your children or have more money to work with and are searching for better dental coverage.
The catch is that you need to enroll during the enrollment period or have a change in your life that qualifies you to enroll at a later date.
Covered California enrollment and qualifications
The enrollment period usually begins in mid-October and runs for a few months. However, if you’ve recently moved, had a baby, came home after active duty, or experienced any number of life-altering circumstances, you’ll have an opportunity to enroll if you do so promptly.
Your income must fall in the range of zero to 400 percent of the poverty level to qualify for assistance through the Covered California marketplace. That range varies depending on how many people are in your household.
For example, if there are four people in your family and you have an income range between $25,100 (at a level of 100 percent) up to $100,400 (the 400 percent level) you’re income eligible for one or more of the plans.
The state also offers the Enhanced Silver plan for those who have income levels which fall between 100 percent to 250 percent of the poverty line.
Even better dental coverage for children
If you’re low-income according to the guidelines, your children’s dental plans are an automatic add-on through Covered California; although, you’ll likely pay an additional charge for adults.
What does this mean for you?
Your child will get better dental coverage through Covered California because many procedures are free, with assistance.
So, there’s not a deductible for x-rays, getting their teeth cleaned, or going to regular exams. Plus, if they need sealants to protect the fragile enamel on their primary teeth, and later on their permanent, that’s covered as well.
All of this means that you’re able to take care of the most critical aspects of your child’s oral health with very little out-of-pocket expense.
Coverage Within Networks
Depending on where you live, you have the choice of two different basic plans that are part of your over-all healthcare insurance.
First, there’s the dental preferred provider plan, or DPPO, which allows you to choose from a variety of dentists who are in the network. There’s also some coverage on out of network procedures through this plan.
Your second option is DHMO, the dental health maintenance organization, which is a smaller network and requires a referral if you need to see a specialist.
Dental coverage for children is an essential benefit which means children’s health coverage automatically comes with their regular health insurance. However, if your child requires procedures beyond the average, you can enroll them in an optional plan as well, to ensure that extra dental work gets covered.
Embedded insurance dental coverage for children
There are 11 providers to choose from when it comes to embedded dental insurance for children. Out of the group, two of them are DPPO as well as DHMO.
What this means for you is that choosing either Blue Shield of California or Health Net will give you the broadest range of options on the embedded portion of your child’s insurance. Additionally, there’s a list of providers available to add-on for better dental coverage.
There are plenty of insurance companies to choose from, but you’ll want to do your research before you make a choice.
Anthem Blue Cross
One provider is Anthem Blue Cross. If you go with Anthem Blue Cross, you’ll have options from a DPPO, or you can also purchase the policy as stand-alone dental insurance.
With this provider, you’ll find that most preventative care is free. Alternatively, there’s a small co-payment. On other services, once you meet the deductible, you’ll pay a portion or co-insurance for the procedure.
Another thing to keep in mind is that there’s an out of pocket maximum that you pay each year, Once you’ve reached that amount, Anthem covers 100 percent of the expenses. Amounts, deductible, and co-insurance vary with the plan you choose.
Keep in mind these are individual plans which you can add on to your child’s embedded dental insurance if needed.
Blue Shield of California
One of the great things about the pediatric dental plan through Blue Shield of California is that no matter which one you choose, orthodontics are covered. There are also benefits that help pay for fillings if your child needs a crown or other restorative procedures.
As if that’s not enough:The insurance includes dental cleanings, x-rays, and other preventative care with no charge or a small co-pay. One last thing to consider here, there’s better dental coverage with no yearly maximum if you stick within the network.
California Dental Network
Another excellent option when you’re researching better dental coverage for children is the California Dental Network. They have three simple plans to explore.
Plan 460 — complete
You can enroll the whole family for less than $20 per month, and your coverage includes the basics. Going in for a cleaning, x-rays, and regular check-ups are free. Included, you’ll find that fillings, extractions, and root canals cost between $14 and $140. That’s a significant cost saving.
Even better —
You get a 30% discount if you need a referral to a specialist.
Plan 411 — enhanced
For under $30 you can pick up the enhanced plan. The 411 includes all the same benefits as the 460 plan with additional coverage for major dental treatments such as porcelain and resin crowns.
If your child needs prosthodontics such as a bridge or a way to fix a broken tooth, this plan has better dental coverage than the previous ones we’ve researched.
And we don’t stop there:
The 411 enhanced dental plan also takes care of part of the cost of full-banded orthodontics. That means if your child is under the age of 19, you’ll have the opportunity to get them braces for less than $2000 in many cases.
One thing you always want to double check is the exclusions. Anesthesia is rarely covered, much like the extractions that are sometimes needed to make room when a patient gets braces.
The best option from the California Dental Network
You can purchase the best dental plan that California Dental Network has to offer for under $40 a month. Plan 595 covers everything that the previous plans take care of and more.
If your child needs a root canal, or any procedures to help their gums stay healthy, this may be the best option for you to consider. They also cover cosmetic dentistry under this plan.
Apply for Better Dental Coverage
There are several ways to apply for dental insurance. You can fill out your application online, or by phone. If you need help filling out the paperwork, you’ll find referrals online.
Another option that’s vital in making the right decision for the best dental coverage is the shop and compare tool, which takes you through a series of steps to determine the provider that will work best for your situation.
Once you fill out the application, the system automatically checks your income to find out if you qualify for free or reduced dental benefits.
If you’re not seeking assistance, there’s a different application on the same website. The truth is that many families want and need help. Chances are if you’re a family of four with an income of less than 100,000 per year, you fall into this category.
After you’ve picked your provider and filled out your application, you’ll pay your premium, if any, and proceed to the member’s area where you’ll find lots of additional resources.
Taking Care of Your Children’s Teeth
One of the best things you can do for your child is to give them the gift of oral health. By keeping up with their regular dental exams and providing the extra dental care they need while they’re growing up, you set a standard for them to follow into adulthood.
No doubt about it, you have a better chance at success with better dental coverage for your children. So, don’t forget to check into California dental coverage and assistance, enroll during the set enrollment period, and keep your scheduled dentist visits.
Why not request an appointment for your child with a caring dentist at the best Fremont California dentist? We’ll go over what your dental plan covers and work with you to make sure everything is in order.
Please feel free to comment on our post with questions, and we’ll do our best to get you answers. We’d love to hear from you!