Dental Coverage from CoveredCA

[photoguy]

Does anybody have experience with dental insurance obtained through CoveredCA (the california ACA health exchange) and can speak to the pros or cons? or have researched this and have opinions on whether the insurance is worth purchasing? if you have purchased a plan, how did you choose the specific insurer/plan?

From some basic research:

* it's available to any family enrolled on the exchange
* they are all unsubsidized
* there are DHMO and DPPO options. The DHMO plans are much less expensive (maybe $10/person/month) whereas the DPPO runs about $50/person/month
* the benefits can be seen here on page 3 for DHMO and page 4 for DPPO http://www.coveredca.com/PDFs/CC-family-dental-plan-booklet-2016.pdf
* here is a more comprehensive price list for one of the DHMOs: https://apply.coveredca.com/hix/dow...cMv-tmkwPcPVGVMcKVPM7IcN5UXFtFZEjsxIRn6-dwlIw

Due to the premiums the DPPO doesn't seem worthwhile (unless you're planning to do a lot of dental work) but the DHMO seems good to me on paper. The DHMO premiums are probably roughly equivalent to cost of regular cleanings and the deductible is $0 with no annual benefit limit. The DHMO copay amounts seem very low to me, and much lower than what we paid on employer based health insurance. I keep feeling there is some gotcha here.

We don't have a regular existing dentist that we want to keep so going to a new one is not an issue.

 

[Options]

DHMO looks like a good deal, especially if premiums are only $10/month, even unsubsidized. Looks about as good as any employer sponsored plan. I lose dental COBRA this month, but thankfully can use CAL-COBRA for another 18 months of medical. As I've had all my dental work done and teeth are in good shape, plan for the next year is to use Groupon for 6 month interval cleanings at about $23 each. Should trouble arise, I can always sign up for Careington dental (a discount plan, not insurance) as there is no waiting period, discounts can be used immediately, and my current dentists accepts.

 

[daylatedollarshort]

I don't know anything about those specific plans, but I do have one possible "gotcha" for low cost dental plans in general. When I looked at some of the low cost dental insurance plans in the past, on review sites like Yelp the dentists were sometimes not rated highly or people thought they tried to get them to pay for unneeded work. So they got patients in through offering low cost plans and then made up for it by recommending a lot of expensive, sometimes unnecessary dental work.

 

[rodi]

We looked at it extensively this year.
Previously, the kids are/were covered automatically under an HMO that comes with their insurance (in our case Kaiser Permanente). But I couldn't find any providers that actually accepted the DHMO insurance.

We looked at the DPPO and it was cheaper than what we could get (based on getting quotes last year) outside of the exchange. Our dentist did take the plans. IIRC - there was another advantage over regular private dental insurance... no waiting periods. (In other words - you can get a crown or filling THIS year - rather than have to wait 6 months to 2 years for coverage.)

Even still - we decided not to take the insurance... It pays off if we have 2 or more fillings or crowns a year... but is a loser if we don't have fillings or crowns. Sure it's a risk - I have a husband and a kid with soft, cavity prone teeth. (My other son and I have great, really hard teeth and don't get cavities as much).

 

[Daniel J]

Thanks for the heads up! I might switch my plan to the DPPO if my dentist takes it. Cost is about the same and benefits appear to be better.

 

[photoguy]

As I've had all my dental work done and teeth are in good shape, plan for the next year is to use Groupon for 6 month interval cleanings at about $23 each.

I had no idea that dentists advertised on groupon. Your price is way lower than I would expect for straight cash payment. The other option I see people discussing (on other forums) is going to Tijuana for dental service. Not really my cup of tea though.

So they got patients in through offering low cost plans and then made up for it by recommending a lot of expensive, sometimes unnecessary dental work.

This is a bit of a concern. I don't want a dentist recommending procedure X when it isn't really necessary. So far with other medical care, the doctors we've used have been very good about the "necessity" of various treatments and long term benefits.

We looked at it extensively this year.
Previously, the kids are/were covered automatically under an HMO that comes with their insurance (in our case Kaiser Permanente). But I couldn't find any providers that actually accepted the DHMO insurance.

My next step is to look through the provider directories and cross that with online reviews.

I'm probably spending way more time on this than it's worth. The premiums aren't that much and maybe I should just try it and see how it turns out.

 

[Options]

I had no idea that dentists advertised on groupon. Your price is way lower than I would expect for straight cash payment. The other option I see people discussing (on other forums) is going to Tijuana for dental service. Not really my cup of tea though.



This is a bit of a concern. I don't want a dentist recommending procedure X when it isn't really necessary. So far with other medical care, the doctors we've used have been very good about the "necessity" of various treatments and long term benefits.




My next step is to look through the provider directories and cross that with online reviews.

I'm probably spending way more time on this than it's worth. The premiums aren't that much and maybe I should just try it and see how it turns out.

Yes, I got the idea of using Groupon from a post here IIRC. No one is going to be able to recommend anything as I've had meticulous care from my dentist of the past 15 years and my teeth are fine as of visit last week. Most I've had were in that time were root canals/crowns which I shouldn't need now as I take much better care of my teeth now. As I said, if anything does arise in the next year where I'll need any kind of work, Ill simply enroll in Carington and go back to my regular dentist who accepts them.