Kevin C. Wong

CoveredCA Dental Plans

There are seven plans available. I want to keep using my current dentist, Kevin T Dowd. I checked and he is not in any of the networks so that immediately disqualifies these three HMO plans:

  • DentaQuest Family Dental HMO
  • Delta Dental Family Dental HMO
  • Blue Shield Family Dental HMO

And leaves four plans:

  • Humana Insurance Company Family Dental PPO ($56.99 per month)
  • Anthem Blue Cross Family Dental PPO ($54.27 per month)
  • Delta Dental Family Dental PPO ($50.45 per month)
  • Blue Shield Family Dental PPO ($53.00 per month)

I guess because it's CoveredCA all the plans are standardized other than monthly premium. So for adults:

  • Yearly Deductible: $50
  • Yearly Benefit Limit: $1500
  • In Network - Checkups: $0
  • In Network - Fillings: 20% Coinsurance
  • In Network - Root Canal: 50% Coinsurance
  • Out of Network - Checkups: 10% Coinsurance
  • Out of Network - Fillings: 30% Coinsurance
  • Out of Network - Root Canal: 50% Coinsurance

Note that for root canals the co-insured person pays 50%

Checkups = Oral Exam, Bitewing X-ray, Cleaning
Root Canal = Extraction, Root Canal, Scaling, Ceramic Crown

A bit of guesswork but I think for me

Cleaning = $130 (3/year)
Exam with Bitewing X-Ray = $200 (once/year)
Crown = $1200 (wild guess)
Root Canal = $600 (wild guess)

If we just go with cleaning/x-rays it's $590 so $50+($59x3) = $227.00 out of pocket, $363 covered by insurance. That means ona low maintenance year I paid $600 insurance + $227 out of pocket = $827.

If I have a crown then it's $1427 me, $963 insurance so I save about $363.
If I have a root canal usually there's a crown afterwards so it's $1727 me, $1263 insurance so I save about $663.

I've had several root canals and crowns over the years but never more than one (root canal+crown or just crown) in a year.

I think overall I'll skip dental insurance especially since all the plans have a yearly benefit limit. If it's something big like I get in major accident and have major tooth work then it's $1500 insurance and the rest me.