You can get dental coverage through the Marketplace in two ways: as part of your ACA’s health plan or through an individual dental insurance plan.
Note: You can’t purchase Marketplace dental insurance unless you have a regular health insurance plan.
Two ways to get dental insurance coverage
i) Health programs that include dental insurance: Some programs purchased through the Marketplace provide coverage for dental care. You’ll be able to see which programs include dental coverage when you compare them.
If insurance plans include dental care, the premium costs cover both medical and dental coverage.
ii) Stand-alone dental programs: In some cases, you will have access to separate, stand-alone dental care plans. You can find these options when you shop for a health plan through the ACA’s Marketplace.
You’ll need to pay a separate premium if you choose an individual dental insurance plan.
Types of dental insurance plans
Marketplace dental plans are divided into two categories: high and low.
Premiums for comprehensive coverage are higher, but copayments and deductibles are lower. As a result, you will pay more each month but less when using dental services.
The low coverage level is associated with lower premiums but higher copayments and deductibles. Thus, you’ll pay less per month but more when you need dental care.
When you shop for dental plans on the Marketplace, you’ll learn about the premiums, deductibles, copayments, and services covered by each program.
Adult and child dental coverage in the Marketplace
Under the Affordable Care Act, the dental policy guidelines are different for adults and children aged 18 and below.
- Dental insurance is considered an essential healthcare benefit for children. That means if you’re getting health insurance for someone under the age of 18, dental coverage should be provided, either as part of a medical plan or as a separate dental plan. Note: As federal law requires health insurance companies to include dental coverage as an essential health benefit for children, you don’t need to purchase a separate dental plan for them.
- Dental insurance is not a mandatory healthcare benefit for adults. Thus, insurers are not required to provide them.
You can get more information about dental insurance plans and providers for 2022 coverage here.