For 7 million Californians, finding a dentist who takes Dental is challenging. A few medical clinics in rural Northern California do, but the closest office with a full schedule is 140 miles away.
That’s partly because dental insurance is not regulated like health plans. That could change under a measure being debated this fall.
Access to a Diverse Network
The best dental plans have vast networks of dentists and offer set rates for procedures, making it easy for everyone to understand costs ahead of time. Preferred provider organization (PPO) dental plans and dental health maintenance organizations (HMOs) are good examples of this type of plan.
However, even these plans may have deductibles or coinsurance charges and restrict the services you can receive from out-of-network providers. This is why it is important to consider geographic access when choosing a dental plan.
Access to the Latest Treatment Techniques
Insured individuals use dental care at much higher rates than those without coverage. Private dental insurance in California offers individuals a range of personalized coverage options, providing comprehensive dental care while allowing for flexibility in choosing dental providers and treatments. Dental plans may be health maintenance organizations (HMOs or DHMOs), preferred provider organization plans (PPOs or DPPOs), or discount or referral programs that contract dentists to discount their fees. These plans often have closed panels that limit subscribers’ choices of dentists.
The ballot measure would also address the ability of dental insurers to impose arbitrary waiting periods before a patient can access treatment. This practice could negatively impact patients’ access to dental care.
Access to the Best Dentists
Much research shows that Americans with dental insurance are more likely to use it. This includes visiting their dentist more frequently, caring for their teeth better, and doing more restorative work when necessary.
Private dental insurance plans are available through employers or individually. These may include preferred provider organization (PPO) plans, dental health maintenance organizations (HMOs), fee-for-service plans, or discount dental programs. PPO dental plans offer a more comprehensive network of providers, while DHMOs prioritize affordability with restrictive networks. Fee-for-service dental plans allow patients to choose any dentist they want, though annual coverage maximums and waiting periods will apply. They also require higher out-of-pocket costs.
Access to the Best Care
Dental insurance plans vary by type, ranging from health maintenance organizations (HMOs or DHMOs) to preferred provider organizations (PPOs or DPPOs) to indemnity plans. HMOs prioritize affordability by requiring patients to choose a primary care dentist within their network and requiring referrals from that dentist for specialist services.
PPOs and DPPOs are more flexible in terms of access to care. These plans typically cover both in-network and out-of-network treatments. Dental discount plans, on the other hand, offer cost-effective savings on services by contracting with networks of dentists who agree to reduce their fees for members. These plans are not traditional insurance but rather membership programs. They are becoming increasingly popular among individuals and employers.
Access to the Best Technology
The ballot measure would increase transparency by requiring dental plans to disclose more information, including how much of their premiums go to administrative costs to patients and providers. It also establishes a minimum percentage of revenue for dental services and allows the state division of insurance to block “unreasonable” price hikes.
CDA is pleased that the 2023-24 California budget protects several recent investments in oral health access and equity, including the first-of-its-kind $50 million investment to build and expand community dental clinics and $10 million for community-based clinical education rotations for dental students to work in dental health professional shortage areas.
The ACA’s comprehensive reform led to more transparency and patient protections, but dental plans remain exempt from many of these rules.
Access to the Best Treatment Options
Dental plans are often exempt from the ACA’s patient protections and transparency rules that apply to medical insurance. This confuses patients and dentists who need to know whether a dental plan is state or federally regulated.
Dental plans may be HMOs, Preferred Provider Organizations (PPOs), dental discount programs, or fee-for-service plans. Some plans also have annual coverage maximums and waiting periods. Dental insurance can be more expensive than paying out of pocket. However, research shows that insurance weakly increases utilization. This is due to insurance’s cost-sharing and moral hazard properties. Moreover, most people with dental insurance have access to the best care in their area.
Access to the Best Resources
The California Dental Association (CDA) provides information and resources to support patients in their oral health. This includes access to free and low-cost dental services and a comprehensive online resource that compares local rate trends by zip code.
CDA has supported legislation in the 2023-24 state budget that protects recent investments in oral health access and equity, including community-based clinical training rotations for dental students and a first-of-its-kind investment in Medi-Cal dental facilities in dental workforce shortage areas.
This ballot measure would permanently extend the state’s recently renewed “managed care organization” tax on dental insurance to help fund Medi-Cal dental services and other programs. But, it needs to address the fundamental issue of who gets the money that patients put toward premiums.
Access to the Best Treatment Options
Several individuals purchase private dental insurance through their workplace. These plans can be HMOs, PPOs, or discount programs.
These plans have closed panels and require patients to see dentists in the plan’s network to be reimbursed. They also often have limited annual coverage maximums and may impose arbitrary waiting periods for specific treatments.
Unlike medical insurance regulated under the ACA, dental plans aren’t subject to the same oversight. They must also be held to the exact minimum benefits requirements as medical plans.
