Visit a dentist or orthodontist with your young child and be told that braces are needed leads one to the question: Should I buy an individual California dental insurance plan to cover the cost of braces for my child? This article addresses this question by examining the cost and benefits of two separate individual PPO dental plans. We’ve found that most people have a strong allegiance to their personal dentist and the orthodontist referred by the dentist. PPO dental plans are the most likely to include your dentist so we’ve focused on the PPO plans.
By way of back ground; individual HMO dental plans require a fixed copayment by the member for child orthodontia. For example, the Anthem Blue Cross Select Net Dental HMO plan requires the member to pay $2,870 for child orthodontia. The monthly premium in Los Angeles County for a child on this plan is $17/month or $204/year. Blue Shield of California does not offer a child-only dental HMO plan in Los Angeles. Delta Dental offers two individual policies for children: CAA55 costs $7/month, $84/year and has an ortho copayment of $2900; CAA54 costs $8/month, $96/year and has an ortho copayment of $2800. The information is current as of May 2011.
One of the PPO dental plans we’ll look at closely is from Anthem Blue Cross of California (ABC) and costs $36/mo. The other plan from Blue Shield of California (BSCA) costs $40.60/month.
First you need to examine the detailed “certificates of insurance” or contracts for these plans. These contracts give the details of how ortho would be paid. In the ABC (Dental Blue Dental Enhanced) plan, pages 12, 13, 18 & 19 seem to describe the ortho benefits. In the BSCA contract (Smile PPO) pages 12, 13 & 22 describe the ortho benefits in most detail. You should look at the entire contract but these pages seem to refer specifically to the ortho benefit.
On the Anthem Blue Cross (ABC) plan, after a 12 month waiting period, the plan will pay a maximum of $500/year for ortho with a maximum benefit of $1000/lifetime. Certain restrictions and limitations apply and you should read about these. So, one would have to be enrolled for 3 years to get the full ortho benefit (1 yr. wait plus 2 years of treatment). 36 months x $36/mo = $1296 in premium. Of course the plan pays for other dental services (cleanings, fillings, etc.) Also the monthly premium may rise on this plan during the 3 year period.
The Blue Shield (BSCA) plan sets the member’s copayment for child fully banded ortho (24 month treatment period) at $2350, after a 12 month waiting period. I don’t know the full cost of ortho treatment and I imagine that it varies based on the patient and the orthodontist doing the procedure. To get the full ortho benefit one must be enrolled in the plan for 3 years (1 yr. waiting plus 2 yrs. Treatment.) 36 months x $40.60/mo = $1416. As with the ABC plan, this plan pays for other dental services (cleanings, fillings, etc.) and the monthly premium may rise on this plan during the 3 year period. So, the member payment for child orthodontia on this plan would be $3,766 ($2350 copayment + $1416 premium.)
Also, both plans restrict the providers to in-network orthodontists for full payment.
To accurately answer whether this is a good deal, we need to know the cost and duration of treatment for a child from an in-network orthodontist. With that information, we can determine whether paying the premium for 3 years and having the dollar benefit of the plan is less expensive than having no insurance.
This information should enable you to answer the question if it makes financial sense to purchase an individual dental plan for a child who need braces. Get the quote for the braces from the orthodontist. Make sure the orthodontist is “in-network.” Compare the discounted in-network rate to the dental insurance premium cost for 3 years and see the result.
If you determine that you do want to purchase a PPO dental policy, just click on this link, or contact us at BenefitsCafe.com 800-746-0045.