Healthy teeth and gums are important for you and your children. Dental disease can affect your overall health, so it’s important that you and your children see a dentist regularly to stay healthy.
The Affordable Care Act
requires that the new health insurance marketplaces offer dental plans for your children. Although the new act does not require dental coverage for adults, some state marketplaces may also offer dental coverage for adults.
Enhancements to Coverage
The ACA prohibits dental plans from using annual or lifetime dollar maximums on children’s dental coverage. In the past, many plans had an annual or a lifetime maximum which capped the amount of dollars the plan would pay on an annual or lifetime basis. You had to pay the cost of care over those limits, but that’s no longer the case for pediatric dental benefits.
The ACA also eliminated exclusions for pre-existing conditions as of 2014. This means that plans cannot deny coverage because of a condition you already had when you enrolled in the plan.
Securing Dental Coverage
In the Health Insurance Marketplace, you can get dental coverage as part of a medical plan (and pay one premium) or by itself through a separate, stand-alone dental plan (and pay an additional premium). In some states, such as California, all medical plans embed pediatric dental benefits. In these states, you will always get dental coverage through a medical plan and have the option of purchasing additional coverage through a stand-alone plan. In other states, such as Washington, you can only get pediatric dental benefits coverage through a stand-alone dental plan.
High and Low Categories of Dental Plans
Out-of-Pocket Limit for Children
- The high option dental plan has a higher premium but lower copayments and deductibles. You will pay more on a monthly basis and less when you actually use dental services.
The low option plan has a lower premium but higher copayments and deductibles. You will pay less on a monthly basis and more when you actually use dental services.
Remember, dental plans are not designed to cover all dental procedures. Many of the procedures that are covered are not covered at 100%, meaning that you will have to share in the costs for those procedures. This is partially accomplished through out-of-pocket costs like deductibles and coinsurance.
If you purchase a dental plan separately from your medical plan, you will have a separate out-of-pocket maximum that applies to your children’s stand-alone dental plan. The out-of-pocket limit is defined as the total amount of money you will need to pay for your dental care including deductibles, coinsurance and copayments. The out-of-pocket maximum is $350 for one child and $700 for two or more children. After you reach this amount the dental plan must pay for all additional covered expenses for the rest of the plan year.
Links to Help You Choose Marketplace Insurance
Healthcare.gov has a number of resources available to help you choose the plan that best fits you. Use these resources when making your decision.
If you have questions or need additional assistance, you may call the Department of Health and Human Services’ Hotline at 800-318-2596.