Some Affordable Care Act (ACA) plans come without dental benefits. Here’s how to help keep your teeth healthy.

Taking care of your oral health is important for your overall health and well-being. And if you decide to buy an Affordable Care Act health insurance plan from the federal Health Insurance Marketplace for yourself or your family, you have options as far as dental benefits go.

Some federal Health Insurance Marketplace plans offer dental benefits, while others don’t. If you choose a plan without dental benefits, you still have some options for getting dental coverage.

Let’s take a closer look at some issues to consider if you have a Health Insurance Marketplace plan and still want dental benefits for you or your family.

Did you know that regular teeth cleanings and X-rays may be available with no deductible or copays with some dental insurance plans? Explore dental insurance plans now.

Do I need dental insurance with an ACA plan?

The answer is maybe. Some Health Insurance Marketplace plans include dental benefits, while others don’t.

The Health Insurance Marketplace plans that have dental benefits are called “embedded plans.” If you choose an embedded plan, you’ll pay one premium for both health insurance and dental insurance. (A premium is the amount you pay each month to have insurance.)

Other Health Insurance Marketplace plans don’t include dental benefits. If you pick a Marketplace plan without dental benefits, you can buy a separate dental plan, which you might see referred to as a stand-alone dental plan.

If you choose this option, you’ll pay 2 monthly premiums: one for ACA health insurance and one for dental insurance. You cannot buy a Health Insurance Marketplace stand-alone dental plan unless you also are enrolled in an ACA health plan.

What kind of ACA dental plans are available?

Stand-alone Marketplace dental plans are offered at 2 levels:

1. High coverage: Marketplace dental coverage at this level has higher premiums but lower deductibles and copayments or coinsurance. A deductible is the amount you pay for covered dental services before your dental insurance starts to pay. A copayment (a copay) is a set amount of money you pay for a covered dental service. Coinsurance is a set percentage you pay per covered dental service.

With a high-coverage plan, you pay more each month to have dental coverage, but you pay less out of pocket for dental services when you need them.

2. Low coverage: ACA dental coverage at this level has lower premiums but higher deductibles and copays or coinsurance. This means you’ll pay less each month to have dental coverage, but your out-of-pocket costs will be higher for covered dental services when you need them.

Does your health insurance not include dental benefits? A stand-alone dental plan can be an option that’s within your budget. Learn more today.

Do ACA plans have different coverage for children?

Yes. Dental coverage for children who are 19 or younger is considered an “essential” health benefit under the ACA. In other words, it’s a category of health services that all Health Insurance Marketplace plans must cover.

An insurance company must offer pediatric dental coverage as part of a family ACA health plan or make it available as a stand-alone dental plan. While dental coverage must be available, you are not required to purchase it.

As an essential health service, pediatric dental benefits come with certain cost protections under the ACA. These include a ban on yearly and lifetime spending limits. This means insurance companies can’t set a yearly dollar limit on what they spend for your child’s dental care. They also can’t set a dollar limit on what they spend on your child’s dental care during the entire time you and your child are enrolled in that health insurance plan.

However, dental coverage is not considered an essential health benefit for adults under the ACA. This means that insurance companies can offer individual Marketplace health plans for adults that don’t include dental benefits. They also don’t have to offer stand-alone dental plans. Additionally, Marketplace dental plans for adults can include yearly and lifetime spending limits.

That said, if you have a dental problem that requires medically necessary care, it may be covered by your Health Insurance Marketplace health plan. You’ll want to talk to your insurance company about what coverage might look like.

What benefits should I consider when choosing dental insurance?

When you’re comparing dental plans, look carefully at the plan descriptions. You’ll want to pay particularly close attention to what the benefits cover, waiting periods, maximum annual coverage amounts and what your out-of-pocket costs might be.

Out-of-pocket costs include:

• Copays and coinsurance
• Deductibles
• Premiums

The deductible for a stand-alone Marketplace dental plan typically is lower than the deductible for an embedded plan.

Dental services are usually grouped into categories. In each category, the plan may pay differently for children and adults. There may be different waiting periods for certain types of services as well. A waiting period is the amount of time your plan must be active before it will cover a service. The different categories often have different out-of-pocket costs and waiting periods:

• Preventive services. This category includes dental services like routine exams, X-rays and cleanings. Preventive services typically have the highest amount of coverage. (This is great for keeping on top of your oral health.) For example, depending on the plan, preventive services may be covered without you having to pay your deductible first, and they may not have copays or coinsurance.
• Basic services. This category might include things like simple fillings, which may be subject to a deductible and require a copayment or coinsurance, depending on the plan. For example, if you receive a filling, you may have to pay a $100 deductible and 30% of the cost of the filling.
• Major services. These would include dental work such as crowns, extractions and root canals. They typically have the most limited coverage, depending on the plan. For example, some major services, such as bridges, dentures and partials and implants, may not be covered at all.
• Additionally, major services may be subject to a deductible and require a copay or coinsurance, which may be higher than for basic services. For example, if you receive a crown, you may have to pay a $100 deductible and 50% of the cost of the crown.
• Orthodontia. This category includes braces, which may not be covered, depending on the plan. A plan may cover braces for children but not for adults, for example. Orthodontia may be subject to a deductible and require a copayment or coinsurance.

Do I have any other options for getting dental benefits?

The answer is yes. If you buy a Health Insurance Marketplace plan without dental benefits, you may also opt to get a plan that combines dental and vision benefits. This might be a good idea, as vision benefits for adults also are not considered essential under the ACA. (Like dental benefits, though, the ACA does require vision benefits for children 18 and under.)

Depending on the program or where you live, another option could be buying into a dental discount program. That’s a monthly or annual membership that offers ways to save on certain in-network dental services. When you sign up, you pay a pre-negotiated price for a dental service directly to a dentist. Dental discount programs are not insurance.

Unlike most stand-alone dental plans, dental discount programs usually don’t have annual caps, copays, deductibles or waiting periods. Ask your dentist if they participate in a dental discount program.

Big bills don’t have to get in the way of your dental health. Here’s how a supplemental dental plan can help keep costs down. Learn more online, or call a licensed insurance agent at 1-844-211-7730 for more information.

Compliance code:
51889-X-0125