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Guide to Understand Your Dental Coverage

We Understand! Dental care can often come with unexpected costs. Your dental insurance serves as a valuable tool to enhance the affordability of Your dental care. That’s why we are in-network, preferred providers, with Your plan!

And for those of you who do not have dental coverage, you can still access affordable dental care through our Membership Program.

Here’s a guide to navigate your PPO, HMO, or Denti-cal Medicaid dental coverage so you can make informed decisions about your oral health.

Please select the option that best describes the type of dental coverage that you have:
    Guide to Maximize the Value of your PPO or Indemnity Dental Plan
    Dental Plans do NOT work in the same way as your Medical Plan:

    While medical plans provide coverage against unforeseen and significantly costly medical treatments, dental plans typically do not follow the same structure. Here’s the reasoning behind this difference:

    • Medical Plans:
      • Have out of pocket maximums to safeguard patients against unexpected highly expensive medical procedures.
      • Medical Plans do not have a cap set on insurance payout.
    • Dental Plans:
      • Do not have out of pocket maximums, and some have an annual cap (i.e. maximum) on insurance payout to protect the dental plan.

    PPO / Indemnity Dental Plans

    • PPO Dental Benefit:
      • Preventative care such as exams, x-rays and basic cleanings are usually fully covered.
      • Insurance Annual payout maximum is generally $1000-$2500. Insurance maximums have been more or less the same since the 1970s.
    • Out-of-Pocket Cost for Dental Services
      • Expect to pay 50% out of pocket for major treatment, such as crowns.
      • If you max out your insurance benefit, remaining treatment will be fully out-of-pocket.
    • Expert Tip to Maximize your PPO Dental Insurance
      • Stay in-network to maximize your benefit.
      • Benefits don’t roll over, so plan ahead and use your benefits each year.
    Guide to Maximize the Value of your HMO or Managed Care Dental Plan
    Dental Plans do NOT work in the same way as your Medical Plan:

    While medical plans provide coverage against unforeseen and significantly costly medical treatments, dental plans typically do not follow the same structure. Here’s the reasoning behind this difference:

    • Medical Plans:
      • Have out of pocket maximums to safeguard patients against unexpected highly expensive medical procedures.
      • Medical Plans do not have a cap set on insurance payout.
    • Dental Plans:
      • Do not have out of pocket maximums, and some have an annual cap (i.e. maximum) on insurance payout to protect the dental plan.

    HMO/ DHMO

    • HMO / DHMO Dental Benefits
      • Preventative care such as exams, x-rays and basic cleanings are covered.
      • As a participating provider in your plan, we receive a monthly check for patients assigned to our office. This amount is only a few dollars and is intended to offset some of our administrative costs.
      • We do NOT generally submit claims to HMO plans for general dental care, because most HMO plans do not pay us for procedures on top of your discounted fees.
    • Out-of-Pocket Cost for Dental Services
      • By accepting your plan, we have agreed to discount the Basic and Major dental care that is covered under your plan.
      • Treatment such as dental implants and cosmetic options like crowns, bridges, and dentures are generally not covered or have additional out-of-pocket costs.
    • Expert Tip to Maximize your HMO Dental Benefits
      • You must see in-network providers to access your benefits.
      • You must be assigned to our practice while being treated by our dentists.
      • If you do not assign yourself to our practice prior to your first appointment, you will be charged our usual and customary fees for all rendered treatment until you become assigned. If you need assistance with this step, please reach out to our team PRIOR to your appointment.
    Guide to Maximize the Value of your Denti-Cal / Medicaid Dental Insurance
    Dental Plans do NOT work in the same way as your Medical Plan:

    While medical plans provide coverage against unforeseen and significantly costly medical treatments, dental plans typically do not follow the same structure. Here’s the reasoning behind this difference:

    • Medical Plans:
      • Have out of pocket maximums to safeguard patients against unexpected highly expensive medical procedures.
      • Medical Plans do not have a cap set on insurance payout.
    • Dental Plans:
      • Do not have out of pocket maximums, and some have an annual cap (i.e. maximum) on insurance payout to protect the dental plan.

    Medicaid / Denti-Cal / PhP

    • Denti-Cal Dental Benefits
      • Preventative care such as exams, x-rays and basic cleanings are covered.
      • Adults have more limited coverage than children. For example, adults only get 1 basic cleaning per year while kids get 2 cleanings.
      • Most major treatments require preauthorization and when approved, the most basic/least expensive non-cosmetic care is covered.
    • Out-of-Pocket Cost for Dental Service
      • Expect to pay out-of-pocket for more enhanced treatment such as dental implants and all cosmetic options like crowns, bridges and dentures.
      • Expect to pay for treatment that requires a specialist because most specialists are out-of-network with this plan. However, we have limited oral surgery slots in some of our locations that are available for covered wisdom teeth extractions.
    • Expert Tip to Maximize your Denti-Cal Dental Coverage
      • Plan ahead and be flexible when and where you get your covered services.
      • Most dentists do not accept Denti-cal, so the schedules of dentists (like us) who are in-network are highly impacted. We appreciate your patience and cooperation.
    		• PPO or Indemnity Dental Insurance
    		• HMO or Managed Care Dental Plan
    		• Denti-Cal / Medi-Cal
    		•  No Dental Insurance / I Don't Know

Below is a list of some of the plans we accept. If you do not see your plan listed here, please contact us 833-925-8326