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Affordable Care Act and How it Affects Your Family's Dental Coverage

Posted by Craig Martin

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Oct 11, 2013 6:02:00 PM

Affordable Care Act

Are you confused by how the new Affordable Healthcare Act will affect you and your family’s dental coverage? Maintaining good oral hygiene is important to a person’s overall health, so making sure you and your family are covered is very important.


At the very basic level, the ACA defines pediatric dental as an essential health benefit along with items like emergency services and lab work. What that actually means for you all depends on how and where you are getting your health insurance going forward. Regardless of where you purchase health coverage next year, the adult members of your family have options when it comes to dental benefits. Companies like offer cost-effective programs that are available to everyone.


Here are some other questions I hope to answer for you.

Q. I have heard that dental care is considered an “Essential Health Benefit” (EHB) under the ACA and all Health plans are required to provide me with dental insurance. Is this the case?

A. While the ACA does define dental services as an “Essential Health Benefit” for children; this does NOT mean dental will automatically be part of your family’s insurance plan, or that you will be covered. Only certain plans are required to cover or even offer dental coverage.

Q. Who will get dental benefits under the ACA?

A. Children’s dental services are included as part of the EHB and defined as pediatric oral health services. So, if you are covered under an individual plan or a small group plan, there is a good chance some level of dental benefits will be included for your children under age 19. With that said, group plans can do this through a stand alone dental offering. You will need to check with your employer if you have benefits available at work.

Q. Didn’t the ACA define children as anyone 26 or younger?  

A. It is true the ACA requires health plans and issuers that offer dependent coverage to make the coverage available until the adult child reaches age 26. However, this guideline does not extend into the definition of  “pediatric” under EHB. “Pediatric” is defined as under the age of 19 in most states, although states have the flexibility to extend such coverage beyond the age of 19.

Q. What plans are required to offer pediatric oral health services?

A. This is when the “where” you get your health coverage becomes a factor. If you purchase coverage through a public (ACA) marketplace, pediatric dental can be excluded from the medical plan as long as that marketplace offers plan(s) with this coverage. In other words, the new state and federal marketplaces will have plans that provide dental for children available. In the federal marketplace and most state marketplaces, you are not actually required to purchase dental insurance.

If you purchase a new individual policy next year, outside the ACA Marketplaces, your plan is required to cover children’s dental. The key here is “new” as it is possible to have a plan that is considered “grandfathered.” Under that scenario, there is no dental requirement.

Only non-grandfathered individual and small group insurance plans are required to offer child dental on or after January 1, 2014.

Q. How do I know if my employer’s plan is a small group plan?

A. The best advice here is to ask whoever handles benefits at your office. The ACA defines small groups as 100 or smaller, but most states define small groups as under 50 employees. States are allowed to keep the definition of a small group at 50 until 2016.

However, this does not mean your employer must now offer you benefits. It only defines what they are required to offer if they do.

Q. If I purchase a medical plan on a state or federal ACA Marketplace, will it include dental coverage?

A. The short answer is maybe. ACA marketplaces are required to offer pediatric dental plans. They may be separate from the medical plan or they may offer medical plans that include dental.

Starting in 2014, the Affordable Care Act requires Americans to have health coverage or pay a fee. But this is not true for dental coverage. You do not need to have dental coverage to avoid the penalty. And for adults, dental coverage is not required to be included in any plans.

Q. I qualify for a subsidy and want to purchase a medical plan that includes dental on an ACA exchange. What do I need to consider?

A. Keep in mind; the plan offered through an ACA Marketplace may only cover your children. Make sure your child’s dentist is in-network to limit your out-of-pocket costs. Medical plans covering dental may have a large combined deductible and non-preventive dental services may not be covered until the deductible is met. You will need to look at each plan closely. You will still get credit for your subsidy if you chose a health plan without dental. For more information on the ACA, visit


Oral health is an important part of overall health and wellness for every family member. Accessing affordable dental care through a dental savings plan is an affordable alternative to insurance. A dental savings plan is like a membership to a warehouse club- consumers pay an annual fee and get access to reduced rates for dental services, cosmetic dentistry and orthodontia, as well as vision services and pharmacy. has been a successful online marketplace for dental and vision savings plans, since 1999.


For more information on how our plans can help you and your family save on dental care and more, check us out at, or call us at 1-855-214-3184.

Topics: Dental Insurance, Affordable Care Act, Childrens Dental Care

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