Obamacare Dental Coverage… Are YOU Covered?

Are you confused by how the Affordable Healthcare Act (ACA) may affect you and your family’s dental coverage? We can help. Here are some answers to the most frequently asked questions about how healthcare reform impacts dental care:


Dental care is considered an Essential Health Benefit under the ACA. Does that mean any healthcare plan I buy will include dental insurance?


The ACA defines pediatric dental insurance as an Essential Health Benefit (EHB). But in this case, under federal law. “Essential” means that dental coverage must be available for you to purchase, not that you actually have to purchase it.


Sounds simple, but it gets complicated very quickly. There is no single law that applies to everyone, in every state:

  • If you buy a plan on the federally-run Marketplace, you are not legally required to purchase dental insurance for your children.
  • If you shop on one of the state-run Marketplaces, you may need to purchase pediatric dental insurance, as a few states either mandate it or are considering doing so (check your state exchange at healthcare.gov for specifics).
  • If you purchase a plan on the private market, you may need to either purchase dental insurance (whether you have children or not) or provide reasonable assurance that you have purchased it or intend to do so.


 Didnt the ACA define children as anyone 26 or younger?  


The ACA requires health plans and issuers that offer dependent coverage to make the coverage available until a dependent 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 can extend such coverage beyond the age of 19.


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


It depends on the plan you choose.


In general you can assume a plan marketed to an adult will not include dental. Some family plans do include dental insurance, or will point you to a separate dental plan that you can add to your healthcare coverage.


A few states are trying to make it easier to spot plans that do include dental (virtually always pediatric dental) by using a tooth icon. Be aware that a plan that includes dental may offer coverage for kids only, read the fine print.


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


If you have a dentist that you like, make sure they accept whatever plan you’re considering purchasing.


Also be aware that healthcare plans covering dental may have a large deductible and non-preventive dental services may not be covered until the deductible is met. Standalone dental insurance plans tend to have a $700 deductible – the amount you pay out of pocket before your insurer begins to contribute to covering the cost. Healthcare plans may have deductibles of several thousand dollars, and that’s at the minimum. Ideally, your plan will offer a lower deductible for dental care


If you buy a standalone dental plan, it may not be covered by a federal subsidy. You may want to look for a healthcare/dental bundle – but again, check the deductible details closely.


Do check which services are covered under your plan – don’t assume you can easily cover the deductible just because your kid needs expensive braces. Orthodontic care, and other services like dentures and implants, may not be covered by every plan.


What is the difference between dental insurance and dental savings plans?


A dental savings plan is like having a membership to a warehouse club. Members pay an annual fee and get access to reduced rates for dental services. You can choose a plan that includes cosmetic dentistry, braces, even vision services and pharmacy. DentalPlans.com carries plans offered by the leading providers.


Oral health is an important part of overall health and wellness for every family member. You may find that a dental savings plan, the affordable alternative to insurance, is the right choice for you and your loved ones.


To learn more, call one of our :DP AtYourService Customer Care Representatives at1-800-238-5163.


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