How to Use Covered California for Dental Insurance: What’s Included and What’s Not
Many Californians hope to use programs like Covered California for dental insurance and affordable health insurance. When it comes to dental insurance, the rules are different. Dental coverage isn’t automatically included in every healthcare plan, and for adults, it’s not a required benefit. However, Covered California offers options that provide dental coverage and care.
Understanding how dental coverage works through the state marketplace can help you choose the insurance plans that are right for you. Learn to use Covered California for dental insurance, what’s usually covered in a dental policy, what’s excluded, and how to apply for the coverage you need.
Understanding Covered California Dental Insurance
Covered California is the state’s official health insurance marketplace, and knowing how to navigate it is the first step in using Covered California for dental insurance or finding other options. While its main focus is medical insurance, it can also connect you with different dental insurance plans.
Dental coverage isn’t included in most adult healthcare plans, but you can buy it through Covered California if you want it. Under the Affordable Care Act, dental benefits are considered an essential health benefit for children. That means pediatric dental coverage is also included in a child’s healthcare coverage.
The marketplace allows you to compare multiple dental insurance coverage options, see insurance companies side-by-side, and find the best dental insurance for Covered California to meet your needs.
Types of Dental Plans Offered
Covered California offers more than one way to get dental benefits and understanding the differences can make it easier to choose the right insurance plan and budget for your dental care.
Covered California offers two main types of dental coverage for adults:
- Embedded Dental Plans: Some family and individual health insurance plans include adult dental benefits as part of the medical coverage. This is relatively uncommon, though, so if you want a plan that includes dental care, you’ll be limited to a few carriers and plan options. These plans are often more expensive, too.
- Supplements Dental Plans: Also called Optional Dental Plans, this is a more common way to get dental care coverage. These plans are a separate insurance plan you purchase in addition to your health insurance.
There are many supplemental dental insurance plans to choose from through Covered California. You can search for a preferred carrier, check that your dentist is included in the in-network coverage, and select a plan that makes the most sense for your budget and dental care needs.
Pediatric Dental Coverage Requirements
If you are enrolling a child through Covered California, pediatric dental coverage is always available through a child’s health insurance plan. It’s a mandatory benefit that ensures kids have access to preventive dental care like cleanings and fluoride treatments. The coverage also includes restorative dental services, such as fillings.
Coverage for Braces and Orthodontics
Certain plans include braces coverage for kids, but limits and conditions will apply. Be sure to read the fine print before enrolling so you know what’s covered and what you may have to pay by yourself.
Dental insurance that covers braces for adults in California is rare and often limited to medically necessary cases. If you are an adult who wants braces, you will likely pay for them out of pocket.
What’s Included in Covered California Dental Plans
Most Covered California dental plans for adults include dental health essentials such as:
- Preventive care: Exams, cleanings, and x-rays
- Basic services: Fillings, extractions, and emergency treatment
- Major services: Crowns, dentures, and root canals
- Discounts or partial coverage for specialist visits
Adult preventive care is often covered at 100%, while major services are covered at various percentages depending on the plan. Children’s coverage is typically more comprehensive and may include orthodontics, sealants, and fluoride treatments.
What’s Not Covered by Covered California Dental Insurance
Understanding what’s excluded in your Covered California dental insurance for adults is just as important as knowing what’s included in Covered California for dental insurance. Common exclusions in adult dental plans include:
- Cosmetic procedures like whitening or veneers
- Most adult orthodontics, unless medically necessary
- Services done outside your provider network
Remember to check the limitations on pre-existing conditions and note your plan’s annual maximum benefit. This information can help you decide whether you need to raise your coverage limits or purchase supplemental dental insurance.
How to Apply for Dental Insurance Through Covered California
Asking yourself, “How do I apply for dental insurance through Covered California?” is a great first step. The process for Covered California dental insurance for adults applications is pretty straightforward. You’ll need to:
- Visit Covered California’s website.
- Select a dental plan.
- Complete your application.
- Submit the required documents.
- Pay your first premium.
Remember, even if you already have health coverage, you can still apply for standalone dental plans during open enrollment periods or after a qualifying life event.
Maximizing Your Dental Insurance
Once you’ve purchased Covered California dental insurance for adults, you’ll want to use your benefits strategically to get the most value for your money. The best thing you can do is make full use of the preventive services like cleanings and exams twice a year.
Not only are these usually included in your coverage, but preventive care can help you avoid paying for more expensive treatments later on. This is good advice for pediatric dental benefits, too. Taking kids in twice a year for preventive dental care can help them build healthy dental habits early in life that carry on through adulthood.
You should also keep close track of your annual maximums and remaining benefits so you know how much coverage you have left before you have to pay out of pocket. This can help you schedule services that aren’t fully covered and avoid unnecessary costs.
Protect Your Smile with Affordable Dental Plans in California
Your dental health plays an essential role in your overall well-being. Make sure you have the dental care you need and the coverage that fits your budget. Whether you are looking for Covered California dental insurance for adults, dental benefits for low-income families, or a supplemental plan to keep your teeth in top condition, Cost-U-Less Insurance can help.
Before you book your next cleaning, contact Cost-U-Less Insurance for help signing up for Covered California and to make sure you get the dental coverage you need. This free service is available by calling 877-423-1543.
FAQs
Are there specific enrollment periods for dental insurance?
Yes. You can enroll in a dental plan during Covered California’s open enrollment period. You can also enroll if you have a qualifying life event, such as moving or losing other coverage. Does Covered California fine for dental insurance lapses? While California fines residents for not having health insurance, this doesn’t apply to dental insurance.
What are the common exclusions in dental insurance policies?
Common exclusions for adult dental coverage include cosmetic dentistry, adult orthodontics, and services that aren’t considered medically necessary. Always read your policy carefully so you understand the exclusions and limitations of your coverage.
Can I get standalone dental coverage if I already have medical insurance?
Yes. Covered California allows you to purchase a standalone dental plan even if your medical coverage comes from another source, as long as you apply during an eligible enrollment period.
Can anyone apply for dental insurance through Covered California?
Covered California dental plans are available to any California resident who meets eligibility requirements for the insurance marketplace. You don’t have to purchase health insurance through Covered California to get dental coverage. You can apply for a standalone plan during open enrollment or a special enrollment period. Just give us a call at 877-423-1543 for free help.
