The Patient Protection and Affordable Care Act will brighten smiles among adults in California in 2016.
For the first time, the Covered California health exchange will offer dental coverage for adults through optional family dental plans available in 2016. While dental benefits for children have been included in the cost of Covered California health plans, the adult dental benefits come at an additional expense.
To purchase the dental coverage, adults must be enrolled in a Covered California health plan.
The period for signing up for health insurance through Covered California, or making changes to coverage, began this month and continues through Jan. 31.
More than 2 million California residents have obtained coverage through the state exchange since it began offering affordable health plans in 2014. The state exchange was created to administer provisions of the Affordable Care Act, which was signed into law by President Barack Obama in 2010.
Five carriers are offering the family dental plans within Covered California’s pricing Region 10, which includes Stanislaus, San Joaquin, Merced, Mariposa and Tulare counties. Adults are eligible for a family dental plan regardless of whether they have children.
The preferred provider plans of Anthem Blue Cross and Delta Dental are available throughout the five-county region; the others, including the Access Dental HMO, Delta Dental HMO, Dental Health Services HMO and Premier Access PPO, are offered only in parts of the region.
The dental plans have comprehensive coverage for children and adults. According to a Covered California booklet, parents can enroll in a family dental plan without including the whole family.
Covered California created standard dental benefits and cost-sharing for patients under the HMOs and PPOs.
With the health maintenance organization coverage, there is no charge for adults and children for diagnostic and preventive services such as X-rays, exams, cleanings and sealants. The co-payments for children and adults are $25 for a filling; $300 for a root canal; $65 for a tooth extraction; and $300 for a crown. For a family with two or more children, the annual out-of-pocket maximum is $700, though it does not apply to adults.
The patient cost-sharing is different with the preferred provider organization plans. There is no charge for diagnostic and preventive services, but patients are expected to pay 20 percent of the cost for fillings and 50 percent for root canals, extractions and crowns. Annual deductibles are $65 for children and $50 for adults. The childrens’ out-of-pocket maximum is $700 for the year; adults have an annual benefit limit of $1,500.
According to the “shop and compare” tool at www.Coveredca.com, an adult in Modesto earning $50,000 a year can purchase the Access Dental HMO for $13 a month; the Delta Dental HMO for $14 monthly; the Dental Health Services HMO for $14 monthly; and Delta Dental PPO for $31 monthly. The other plans listed cost $49 to $56 a month.
In Modesto, parents with two children, with a household income of $60,000 a year, can purchase the Access Dental HMO for $26 a month; the Delta Dental HMO for $28 a month; or the Dental Health Services HMO for $28 a month. Quotes for other plans were much higher. Remember that a child’s dental benefits are included in Covered California health insurance plans at no extra charge.
Ken Carlson: 209-578-2321