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You may be surprised to learn that many adult Americans don’t have dental insurance. It’s possible that someone with health insurance doesn’t have dental coverage because insurance providers are not required to offer it for adults as a part of their Affordable Care Act (ACA)-compliant plans.
It can be difficult to find a health insurance plan that offers dental coverage, and even then, your dental insurance will likely come with additional limitations and annual maximum benefits separate from your health insurance policy. If you’re looking into buying dental insurance through the healthcare marketplace, there are some things you should consider.
How to Buy Dental Insurance Through the Healthcare Marketplace
When referencing the marketplace in relation to healthcare, the term is referring to a place where you can browse and purchase private individual or family healthcare plans. Through a healthcare marketplace, you are able to buy dental insurance in two primary ways: through a health plan or through its own separate plan.
During open enrollment, you can create a profile and view dental and health insurance plan options for the coming year. So long as you sign onto coverage during open enrollment, your coverage will go into effect on Jan. 1 of the next year and last until the end of the calendar year. In some circumstances, you might also qualify for a special enrollment period that allows you to shop for insurance outside of the standard open enrollment period. Getting married, moving to a new state and having a child are all circumstances that may qualify you for a special enrollment period.
Some states have created their own insurance marketplace with state-specific providers, while others defer to the federal marketplace. For example, Pennsylvania has created its own marketplace website called Pennie, while residents of Tennessee will shop through the national health insurance marketplace found at Healthcare.gov.
The following are ways you can purchase dental insurance through the healthcare marketplace.
Dental coverage as part of a health plan
While dental coverage is less commonly offered in conjunction with a health plan, there are plans that offer both health and dental coverage. You can compare different health plans to see which cover dental care. If a plan offers dental coverage, the cost will be included in the premiums you pay.
Keep in mind that health insurance providers are not required to offer dental coverage to adults who purchase ACA-compliant plans through their companies. While child dental care is a required benefit under the ACA, this requirement does not extend to adults. This makes it especially important to know exactly what type of dental coverage is and is not included on your plan when you sign up for insurance.
Dental coverage as a stand-alone plan
You can also buy a stand-alone dental plan through the marketplace. In this case, you would be paying additional premiums for the coverage in addition to the premiums you pay for your basic healthcare coverage. In addition to premiums, dental insurance you purchase independently from health insurance will come with their own deductibles, copayments, annual maximums and other limitations.
Advantages of Buying Dental Insurance Through the Healthcare Marketplace
Buying dental insurance through the healthcare marketplace has its advantages. Whether you’re considering getting dental coverage through a health plan or on its own, the following are some advantages to consider:
- Easy comparison: When you are researching the marketplace, it is easy to compare different health and dental plans. You’re able to see each plan’s copayments, deductibles, costs and covered services in one place. When trying to find a health plan that has dental insurance included, or trying to find a stand-alone dental plan, it’s easier to find a good plan when you can easily compare different plans offered.
- Several options: When buying dental insurance through the marketplace, you have access to the two categories of dental plans. These categories include high-level coverage plans and low-level coverage plans. High-level coverage plans offer higher premiums but lower copayments and deductibles. Low-coverage plans offer lower premiums but higher copayments and deductibles.
- Dental coverage is required for kids: Through the ACA, insurers are required to offer dental coverage to children younger than 18. The coverage can be offered as part of a plan or as a stand-alone plan because it is considered an essential health benefit for kids. This is an advantage if you have children because you don’t have to worry about getting dental coverage for them like you would when you buy an independent plan from a third-party insurance provider.
Disadvantages of Buying ACA Dental Coverage
While the ACA can be beneficial, it also has its drawbacks, especially when it comes to dental coverage. Disadvantages of buying ACA dental coverage include:
- The ACA does not require dental coverage for adults: Dental insurance is not required to be offered by insurers for adults, which can sometimes make it difficult to get when you’re buying a health insurance plan. This means you might need to review dozens of plans before you find one that offers dental benefits that fit your needs.
- The cost isn’t good for everyone: While the Affordable Care Act has made it easier for some people to afford dental coverage, for others who don’t qualify for subsidies, these marketplace healthcare plans may not be affordable. If this is the situation you’re in, you might find independent dental plans more appealing because you can find coverage for just a few dollars a month.
- Smaller provider networks: While implementing ACA requirements, many insurance companies shrunk their network of providers. This means you will have fewer providers to choose from when you purchase a plan through that insurer. The effort to support and promote the ACA has caused the program to dwindle.
- Shopping can be complicated: While a marketplace brings all options into one place, it can still be complicated to shop for a plan. The enrollment periods are typically limited and sometimes there are so many options to choose from that you have no idea which to select.
How Do Consumers Qualify for Medicare and Medicaid Dental Coverage?
To get Medicaid or Medicare dental coverage, you must qualify for the programs themselves. Medicaid is a state and federal program that provides health insurance to many Americans, especially those living on a lower income. Medicare is a federal health insurance program set in place for older adults and those living with certain disabilities. However, some requirements need to be met to be eligible for either of the programs.
To qualify for Medicaid you have to be financially eligible, meaning your income has to fall below or at the established amount. To qualify for Medicare, you must be older than 65, have a qualifying disability or be suffering from end-stage renal disease. If you qualify for the program, you automatically qualify for dental coverage.
Even if you qualify for one of these programs and their dental coverage, it does not necessarily mean it will be easy to get. For Medicare, dental services aren’t typically covered, but there are options to choose from outside of the marketplace. Depending on your age and income, you can look elsewhere. Select states may offer dental coverage through Medicaid, but it’s not a national requirement.
Compare Dental Insurance
If you cannot find a dental insurance plan through the marketplace, you can purchase an independent plan. Benzinga offers insights and reviews on the following dental insurance providers. Consider beginning your search for insurance using the links below.
- Best For:Young adults and families with children and teenssecurely through Guardian Dental Insurance's website
Frequently Asked Questions
What is dental insurance?
Dental insurance helps you pay for the cost of routine and corrective dental treatments, including regular cleanings, exams, root canals, crowns and fillings.
How much does dental insurance cost?
As an individual, you can expect to pay between $16 and $70 per month for your dental insurance.
More on Dental Insurance
Dental Insurance Methodology
To determine the best dental insurance providers, we pored through all United States carriers. We winnowed the list by only including companies that have a wide coverage area and product offering. To further break down the list to the true best dental insurance providers, we gave weight to carriers that offer discounts, are available in all states and have multiple payment plan options.
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About Sarah Horvath
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