The California Society of Pediatric Dentistry Membership Services Committee has produced the following that may be of value to you when negotiating the intricacies of choosing a health care plan through one of three available avenues: Employer-Sponsored Insurance; Stand-Alone Dental Plans (Exchange or Non-Exchange); or Medi-Cal or CHIP programs.
A special and well deserved thank you goes to CSPD member Dr. Cheryl Willett who, with the able assistance of other committee members, developed the language and content of the following information:
The ACA states that pediatric dental services be available for children 0-19 years of age. Families in California may acquire dental insurance through one of the following ways: Employer-Sponsored Insurance, Stand-Alone Dental Plan (Exchange or Non-Exchange), Medi-Cal or CHIP programs.
Starting October 1, 2013 Covered California will have the Stand-Alone dental plans available. The press release can be seen by clicking here. They will offer optional stand-alone dental plans rather than bundling or embedding the dental plans with medical plans. There has been much controversy surrounding this decision and how it will affect affordability and access to dental care for California children. Covered California has announced their plans to re-evaluate their decision for 2015. For now, they will be offering DHMO, DPPO, DEPO plans from Anthem Dental, Blue Shield of California, Delta Dental of California, Health Net Dental, LIBERTY Dental Plan and Premier Access Dental. Specific plan information is available at this link.
Who could be selecting plans offered by Covered California or changing insurance plans?
Anyone who does not have affordable employer based dental insurance or doesn’t have dental insurance at all or who doesn’t qualify for Medi-Cal or CHIP programs. A flow chart of who qualifies for what type of insurance can be found in this article.
How does this affect pediatric dental care and patients?
The current way that the information is presented can be confusing to consumers. We are concerned that this confusion between DPPO’s, DEPO’s and DHMO’s under the same brand name insurance, the lure of low premiums, poor provider networks, and lack of specialty services with some plans may lead to a reduction in pediatric dental access for California children.
The CSPD has created a flier so that families will have the appropriate information before changing dental insurance plans which may limit their access to pediatric dental services or affect their access to their current dental providers. Download the patient flier at www.cspd.org.
The CSPD and CDA are working with Covered California to advocate for changes to the 2015 plans to ultimately improve access to pediatric dental care for all California children. Please check www.CSPD.org for continuing updates.