Dental Benefit Plans

The state of California is reviewing Medi-Cal eligibility. Dentists can share outreach materials with their Medi-Cal patients to help ensure they receive important information and updates about their coverage. 

CDA member-dentists can use their voice in two important ways to support dental plan reform and CDA’s advocacy efforts this year: (1) Tell your legislator to support two CDA-sponsored bills that address loopholes in dental plan standards and regulations; and (2) Tell us how your patients’ coverage is disrupting care.
 

Whether you are in the process of deciding if you should contract with dental plans or need assistance managing existing dental plans, rely on CDA’s resources and experts for advice and education.

Two CDA-sponsored bills introduced this month, including one authored by Assemblymember Jim Wood, DDS, continue CDA’s legislative efforts to hold dental insurance plans accountable and move toward more meaningful dental coverage.

On behalf of members, CDA has filed a legal action against Delta Dental of California in San Francisco Superior Court. The action challenges Delta Dental’s adjustments to Premier and PPO provider agreements effective Jan. 1, 2023.

The Department of Managed Health Care asked Delta Dental to report any rate changes affecting over 10% of its provider network to the department. Additionally, DMHC is monitoring its help desk for calls from consumers.  

In Tuesday’s election, Massachusetts voters overwhelmingly supported a ballot measure that will require Massachusetts dental plans to spend at least 83% of premium dollars on patient care rather than administrative overhead costs and executive compensation. 
 

The Biden administration this week expanded coverage for medically necessary dental procedures in Medicare. Coverage of some services — specifically, elimination of infection preceding an organ transplant and certain cardiac procedures — will begin in 2023, while coverage of dental services linked to head and neck cancers will start in 2024.  

Update 11/9/22: The CDA-endorsed ballot measure in Massachusetts – Question 2 – passed in Tuesday's election and will require dental insurance companies to spend at least 83% of premium dollars collected on dental services as opposed to using the money for administrative costs and executive compensation.

A proposed rule from the Center for Medicare & Medicaid Services would cover medically necessary dental services as part of the existing medical services benefit in Medicare. CDA last week submitted specific recommendations on coverage of services.
 

Reports from CDA members during the last week on contract change notification letters sent by Delta Dental of California raise additional concerns for CDA about the proposed changes. 

Delta Dental of California is revising its Delta Dental of California Participating Provider Agreement effective June 1, 2022. Although described as an “enhancement,” the contract amendment alters reimbursement for Premier or PPO contracted dentists who treat DeltaCare® enrollees as out-of-network providers.