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Delta Dental Insurance - Health Care Exchange (Marketplace) FAQs for Individuals

Health Care Exchange (Marketplace) FAQ for individuals

Whether you have a Delta Dental Health Care Exchange (Marketplace) plan or you’re still considering one, you can find the answers to your most common questions here.

Health Care Exchange (Marketplace) FAQ for individuals

Whether you have a Delta Dental Health Care Exchange (Marketplace) plan or you’re still considering one, you can find the answers to your most common questions here.

Enroll in a plan

Already enrolled?

Find the right dental plan

We can help make choosing the right dental plan for yourself and your family a breeze.

Simply visit HealthCare.gov or your state's exchange website (e.g., Covered California) to view the dental plan options available to you and choose a plan.

Delta Dental offers ACA-compliant dental plans in 15 states, plus D.C., including pediatric-only plans and options for families.

Plans on the Health Care Exchange (Marketplace) are categorized as high coverage and low coverage. A high coverage plan means you’ll pay a little more each month (in premiums), but you’ll owe the dentist less for covered services (and more may be covered, depending on your plan). With a low coverage plan, you’ll pay a little less each month (in premiums), but you’ll owe the dentist more for covered services.

Beyond offering you high and low dental coverage options for children and families, you can also choose between a PPO and copay plan.

Delta Dental PPO™¹

  • Our coinsurance plan shares your costs for covered services.
  • After you meet your annual deductible, Delta Dental pays a percentage of your bill and you pay the rest.
  • You can visit any dentist, but you’ll save the most with a Delta Dental PPO dentist.
  • Children can use their benefits immediately — adults may have a waiting period for Major Services.

 

DeltaCare® USA¹

  • Our copay plan works like a dental HMO.
  • You must visit your selected DeltaCare USA dentist to receive benefits.
  • When you visit the dentist, just pay your predefined copayment and you’re all set.
  • You’ll know all copayments up front, so you can plan ahead for treatment costs.
  • Use your benefits right away — there’s no waiting period on children or adult services.

In most states, open enrollment for individual plans on the Health Care Exchange (Marketplace) starts on November 1 to obtain dental insurance for the new year. Check healthcare.gov for exact open enrollment dates for your state.

If you’re already a Delta Dental member, you should be set with your current group coverage. For questions about your employer plan, reach out to your company’s benefits representative.

If you already have individual dental coverage, you can keep your current coverage or you can explore our plans on healthcare.gov.

Yes.

Yes. In order to purchase stand-alone dental coverage on the exchange, members must have medical coverage.

Using your dental benefits

Once you have a Health Care Exchange (Marketplace) dental plan, you'll want to make the most of it. Here's how.

Once we’ve received your payment, and you have enrollment confirmation, you can start using your benefits on or after your effective date.

If you’ve recently enrolled in a Delta Dental plan on healthcare.gov or through your state’s Health Care Exchange (Marketplace), it may take up to 10 business days from the date you signed up for your enrollment to be processed. Once your enrollment is activated, you’ll receive a confirmation from us via email and/or postal mail. You can also check your enrollment status online at any time.

With an online account, you can find a network dentist, check benefits information (including eligibility and claims), make payments, view or print ID cards and get cost estimates for care. (Note that cost estimates are not provided for DeltaCare USA because copayments are provided up front.)

Once you’ve received enrollment confirmation from us, simply sign up for an online account. Select “Enrollee/Adult Dependent” from the initial drop-down menu and follow the prompts to create your account.

ID cards are not needed to use your benefits. You can simply give your dentist your name, date of birth and social security number or member ID to verify coverage. If you prefer having an ID card in hand, you can print one by logging in to your online account or display it on your mobile device.

The quickest way to check your benefits and make payments is online. Simply log in to your account to access payment information, including the option to set up autopay and avoid missing payments. You can also pay your invoice via check or by calling us at 888-857-0337. 

Find or switch to a new dentist 

It's easy to find a dentist that meets your needs with a Delta Dental Health Care Exchange (Marketplace) plan. Here are some tips on finding or switching to a new dentist.

If your current dentist is in-network for the plan type you selected, then you’re good to keep that dentist. If your dentist is not in-network, here’s how it works:

  • With a Delta Dental PPO plan, you can visit any licensed dentist to receive benefits. However, you’ll usually save the most when you visit a PPO network dentist because these dentists accept reduced fees for plan enrollees.
  • If you have a DeltaCare USA plan, you must select a dentist in the DeltaCare USA network to receive benefits.

To find a network dentist by location, just use our Find a Dentist tool.

Select the network that corresponds to your plan and search. For a more targeted search, you can enter the name of your dentist or dental office.

Delta Dental PPO members can change their dentist at any time — there’s no need to notify us.

DeltaCare USA members who want to select or change their primary care dentist should make the request via their online account or by telephone at 888-857-0337. All DeltaCare USA dentist changes requested by the 21st of the month will take effect the first day of the following month.

1. DeltaCare USA is underwritten in these states by these entities: CA — Delta Dental of California; DC, FL — Delta Dental Insurance Company; MD, TX — Alpha Dental Programs, Inc.; NV — Alpha Dental of Nevada, Inc.; UT — Alpha Dental of Utah, Inc.; NY — Delta Dental of New York, Inc.; PA — Delta Dental of Pennsylvania. Delta Dental Insurance Company acts as the DeltaCare USA administrator in all these states. These companies are financially responsible for their own products. The plan is a dental HMO in CA and TX.

Delta Dental PPO is underwritten by Delta Dental Insurance Company in AL, DC, FL, GA, LA, MS, MT, NV and UT and by not-for-profit dental service companies in these states: CA — Delta Dental of California; PA, MD — Delta Dental of Pennsylvania; NY — Delta Dental of New York, Inc.; DE — Delta Dental of Delaware, Inc.; WV — Delta Dental of West Virginia, Inc. In Texas, Delta Dental Insurance Company provides a Dental Provider Organization (DPO) plan.