What Are the Requirements for Getting a Family Dental Plan? 

Posted: November 09, 2022

Practicing good dental care is essential for people of all ages. A good oral care health plan includes brushing and flossing, drinking fluoridated water and avoiding sugary foods and drinks. Going to the dentist is another vital step that can help prevent gum disease, tooth loss and other dental issues. The Centers for Disease Control (CDC) recommends adults visit the dentist at least once a year and that children start receiving dental care by their first birthday.

Dental care is vital for maintaining your family’s oral health, but the costs of visits can add up. Enrolling in a family dental plan can help lower out-of-pocket costs for a dentist visit and make dental care more affordable. Review the California family dental insurance requirements below to find your best option.

Requirements for Family Dental Plans in California

While family dental plans offer varying levels of coverage, some of the requirements for enrolling are universal. You must meet the following primary qualifications for family dental plans to get a family plan for you and your household:

1. Purchase a Health Plan through Covered California

You must first enroll in a health plan to be eligible for purchasing a family dental plan. While some health plans for adults include dental insurance, many don’t. You may need to purchase this coverage separately from your health plan if you want dental coverage for everyone in your household.

Adults can purchase dental coverage for themselves as supplemental dental insurance. However, you may not choose to buy it if you prefer to enroll everyone in your family in a dental insurance plan. If this is the case, you’ll then need to select and purchase a family dental plan to obtain coverage for the entire family.

2. Enroll at Least One Adult in Your Family Dental Plan

Once you purchase a health plan, your children will automatically receive dental coverage as part of that plan.

Insurance companies treat adult and pediatric dental insurance differently. Pediatric dental coverage is part of the 10 essential health benefits that all plans on the Covered California Health Exchange must offer. Several plans off the Exchange also include pediatric dental insurance. However, dental coverage for adults does not qualify as an essential health benefit.

Because a family dental plan covers multiple family members, you must enroll at least one adult before enrolling any of the children in your family. This requirement separates family dental plans from the essential pediatric dental care that all Covered California Health Exchange plans include. The enrolled adult:

• Must be 19 years old or older.
• Can be yourself or another parent or family member.

While only one adult is required to enroll, every adult in your household can obtain coverage under a family dental plan.

3. Enroll All Children in the Plan if Any

If you’re interested in California family dental insurance, you’ll want to know ahead of time if you plan to enroll any of your children. If you enroll one child in a family dental plan, you must enroll every child in your household under 19.

This requirement for family dental plans ensures that all children receive the additional benefits included in the plan. If your children have essential pediatric dental care, they could miss out on going to their regular dentist if they aren’t in the same network as your child’s health plan. Enrolling your children in your family dental plan enables the two plans to coordinate coverage and give your children the best possible care.

Things to Consider When Comparing Family Dental Plans

Now that you know you meet the qualifications for family dental plans in California, you may be wondering how to select the best coverage for you. Choosing the right insurance requires investigation and depends on your family’s specific needs. Here are a few considerations to remember when searching for the right dental coverage for your family:

1. DMO vs. PPO

Just as with a family health insurance plan, dental insurance in California comes in two main types:

• Dental Maintenance Organization (DMO): A DMO plan works similarly to a Health Maintenance Organization (HMO), except for being tailored to dental care. DMO family dental plans provide services from a primary dental physician within the plan’s network. This provider coordinates care for you and your family members. If anyone in your family requires specialized dental services, your primary dentist will refer you to a specialist.
• Preferred Provider Organization (PPO): A dental PPO plan gives you more flexibility in selecting the dental providers you and your family visit. Your dental coverage will follow you and any other family members on this plan, although you may incur higher fees for selecting a provider outside your plan’s network.

2. Cost

The cost of family dental insurance is a vital factor in your decision. Consider these dental insurance costs as you compare plans:

• Monthly premiums: The amount you pay for your dental coverage each month is your monthly premium. DMO plans may offer a lower premium than PPO plans, although PPO plans provide more flexibility in which providers you and your family can choose.
• Deductibles: Your deductible is the amount you must pay out-of-pocket for dental services before your insurance provider fully or partially covers the additional costs. Deductibles usually don’t apply to routine dental services like teeth cleanings or x-rays.
• Yearly maximums: Dental insurance companies often have a yearly maximum amount they will pay for your family’s dental services. After reaching your plan’s annual maximum, you’ll have to pay all the remaining costs. Yearly maximums for dental plans range from $750 to $2,000.

The cost of a family dental plan may vary based on factors like:

• The plan you choose.
• The number of family members enrolled in the plan.
• Your household income.
• Your ZIP code.

3. Coverage

While cost is a significant consideration in picking a dental insurance plan, cheaper doesn’t always mean better. Look for a plan that provides coverage for the services you need. Most family dental plans cover services like:

• Teeth cleanings.
• Oral exams.
• X-rays.
• Treatments.

3. Waiting Periods

Some dental insurance includes a waiting period, in which dental coverage doesn’t apply to specific services. For example, major services like fillings or crowns may be subject to a six-month waiting period and the removal of braces could be longer. Some plans may waive the waiting period if you provide proof of prior dental coverage.

If you or your family members need more frequent dental services, a plan with a shorter waiting period may help you cover the cost of care.

Find the Right Family Dental Plan for You and Your Family

Having adequate dental insurance provides several benefits, from helping you prevent gum disease to reducing out-of-pocket costs for dental services. When you need dental coverage for yourself and your family, Health for California is here for you.

Finding a family dental plan through Health for California is straightforward. Our online application process is fast and accurate so that you can enjoy a less complicated insurance application process.

You can sign up for dental and health insurance quickly with our online application and our experienced agents are always available to answer your questions. If you want to learn more about our family dental plans and receive help finding the best option for you, request a free quote today.