Health Care Exchange (Marketplace) FAQ for Individuals

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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.

  • How do I find the right dental insurance for me or my family?
    How do I get a Delta Dental Health Care Exchange (Marketplace) plan?
    To get stand-alone dental coverage for children, adults, or the entire family, visit healthcare.gov to explore Delta Dental’s ACA-compliant plans.
    What types of exchange plans does Delta Dental offer?

    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!). 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 PPOTM1
    • 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.
    When is open enrollment for individuals on the Health Care Exchange (Marketplace)?
    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. (For California residents, open enrollment starts on October 15.) Check healthcare.gov for exact open enrollment dates for your state.
    I already have Delta Dental coverage through my employer. What do I need to know?
    If you’re already a Delta Dental enrollee, you should be set with your current group coverage. For questions about your employer plan, reach out to your company’s benefits representative.
    I already have individual dental coverage. What do I need to know?
    If you already have individual dental coverage, you can keep your current coverage or you can explore our plans on healthcare.gov.
    If I purchase medical benefits through the Health Care Exchange (Marketplace), can I still purchase separate dental benefits?
    Yes.
    Do I have to have medical coverage if I want to buy a dental plan on the Health Care Exchange (Marketplace)?
    Yes. In order to purchase stand-alone dental coverage on the exchange, enrollees must have medical coverage.
  • What do I need to know to start using my dental benefits?
    I signed up for a Delta Dental plan, but I haven’t received anything from you. How do I know if I’m enrolled?
    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.
    What are Delta Dental’s Online Services? How do I sign up?

    With Online Services, 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 on our website. Select “Enrollee/Adult Dependent” from the initial drop-down menu and follow the prompts to create your account.

    How do I get an ID card?
    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 enrollee ID to verify coverage. If you prefer having an ID card in hand, you can print one by logging in to Online Services or you can display it from a mobile device.
    When can I start using my dental benefits?
    Once we’ve received your payment, and you have enrollment confirmation, you can start using your benefits on or after your effective date.
    How can I check my benefits and make payments? Can I do it online?
    The quickest way to check your benefits and make payments is online. Simply log in to your Online Services account from our website. You can also pay your invoice via check or by calling us at 888-857-0337.
  • How do I find or switch my dentist?
    Can I keep my same dentist if I switch to a Delta Dental Health Care Exchange (Marketplace) plan?
    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.
    How do I find a network dentist?

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

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

    Can I change my network dentist? How?

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

    DeltaCare USA enrollees who want to select or change their primary care dentist should make the request via our online customer request form 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.

1DeltaCare 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.