Covered California does include dental coverage, but only automatically for children. Every health plan sold through the marketplace comes with embedded pediatric dental benefits for anyone under 19 at no extra cost. Adults 19 and older get no dental benefits through their health plan and must purchase a separate standalone dental plan as an add-on.
Pediatric Dental Is Built Into Every Health Plan
If you enroll a child under 19 in any Covered California health plan, dental coverage is included in the premium. You do not buy a separate plan for them. Preventive services such as cleanings, exams, and X-rays are available as soon as the medical plan takes effect.1Covered California. Dental Insurance The benefit runs through the last day of the month in which the child turns 19.
For the 2026 plan year, pediatric dental carries a $350 individual deductible and a $700 family deductible when two or more children are enrolled. Preventive and diagnostic services are exempt from the deductible entirely.2Covered California Board Meetings. Proposed 2026 Dental Standard Benefit Plan Designs
One important limit: braces and other orthodontic treatment are not part of the standard pediatric benefit. Orthodontia is covered only when a child meets the medical necessity criteria of the California Children’s Services (CCS) program, and the dental plan refers eligible children to their local CCS office for a determination.3Legal Information Institute. California Code of Regulations Title 10, 2699.6709 – Scope of Dental Benefits for Subscriber Children Routine cosmetic braces are not covered.
Adults Must Buy a Separate Dental Plan
Adult dental is sold through Covered California as a standalone “family dental plan” that you add on after choosing a health plan. You cannot buy the dental plan on its own; a Covered California health plan has to come first.1Covered California. Dental Insurance The word “family” in the plan name is a bit misleading. Single adults, couples, and families with children can all purchase one.4Covered California. Dental Insurance
You pick between two plan types:
- DHMO (Dental Health Maintenance Organization). Lower premiums, set copayments per service, and no waiting period for major work. You stay inside a smaller network and need a referral to see a specialist.
- DPPO (Dental Preferred Provider Organization). Higher premiums with the freedom to see any dentist, in or out of network, without a referral. Out-of-network care costs more, and major services carry a six-month waiting period for adults.5Covered California. Add-On Family Dental – What You’ll Pay for Your Dental Care
What Adult Dental Plans Cover
Adult dental on Covered California is grouped into three tiers for the 2026 plan year:6Covered California Board Meetings. 2026 Dental Standard Benefit Plan Designs
- Preventive and diagnostic services — oral exams, cleanings, and X-rays — are covered at no charge, with no deductible.
- Basic services such as fillings and other restorative work have 20% coinsurance after the deductible.
- Major services, including root canals, crowns, bridges, dentures, and oral surgery, carry 30% to 50% coinsurance after the deductible, with the DPPO waiting period applied.
Several common services sit outside the plan entirely. Adult dental plans on Covered California do not cover tooth whitening, orthodontia (braces for adults), dental implants, or veneers.6Covered California Board Meetings. 2026 Dental Standard Benefit Plan Designs Those services are an out-of-pocket expense or something to shop for outside the marketplace.
What You’ll Pay Out of Pocket
For 2026, the adult dental deductible is $350 per person. If two or more adults in a household enroll, the family deductible is $1,500. Preventive and diagnostic services never count toward the deductible.2Covered California Board Meetings. Proposed 2026 Dental Standard Benefit Plan Designs
DPPO plans also cap what the plan pays for major services at $1,500 per year. Once the plan has paid that much toward major procedures, the rest of the year’s major-service costs are on you.7Covered California. DPPO Dental Insurance Plan Details
Standalone adult dental plans sold through the marketplace are not eligible for the federal cost-sharing reductions that lower deductibles and copayments on health plans based on income.8CMS. Stand-alone Dental Plans – Dental Coverage in the Marketplace Your dental premiums and out-of-pocket amounts are what they are, regardless of income.
Waiting Periods and Preexisting Conditions
DHMO plans let you access major services the moment coverage starts. DPPO plans make adults wait six months before the plan will cover crowns, root canals, dentures, and other major work.7Covered California. DPPO Dental Insurance Plan Details
That waiting period can shrink. Give your dental carrier proof of prior dental coverage, and the plan reduces the wait by one month for every month of coverage you can document. Six months of continuous prior dental coverage waives the waiting period completely.7Covered California. DPPO Dental Insurance Plan Details
As of January 1, 2025, California law bars dental plans from denying claims based on preexisting dental conditions. A plan cannot refuse to cover treatment for a tooth that was already damaged or missing before your coverage began.9California Legislative Information. AB 1048 – Dental Benefits and Rate Review This ended what was long known as the “missing tooth clause.”
Medi-Cal Dental If Your Income Is Lower
If your income is low enough that you qualify for Medi-Cal instead of a subsidized Covered California health plan, dental benefits come with it at no cost. Medi-Cal Dental covers exams, cleanings, X-rays, fillings, extractions, root canals, crowns, dentures, and periodontal treatment for both children and adults.10DHCS. Medi-Cal Dental You don’t apply separately. When you submit a Covered California application, the system checks your household income and routes you to Medi-Cal if you qualify.
When You Can Enroll in Dental
Dental follows the same calendar as health coverage. Open enrollment runs November 1 through January 31. Enroll by December 31 for coverage effective January 1; enroll in January and coverage starts February 1.11Covered California. Covered California Encourages All Californians To Explore Health Insurance Options Before Dec. 31 Deadline
Outside that window, you can add dental coverage only if you have a qualifying life event, such as:12CA Department of Insurance. Qualifying Life Events
- Gaining or losing a dependent through birth, adoption, marriage, divorce, or a child aging out.
- Losing other coverage because of a job loss, an employer dropping its contribution, or aging off a parent’s plan.
- Becoming a permanent California resident during a month outside open enrollment.
- Returning from active military duty, being released from incarceration, or receiving a court order requiring coverage.