Whether you are looking for supplemental dental insurance because your employer- sponsored health plan doesn’t include dental coverage, you’re a senior on Medicaid, or because you buy your own health insurance, the next step is deciding where to purchase a policy.
You have two options:
- The private dental insurance marketplace or
- Your state-based or the federally facilitated insurance Exchange
We’ll talk about each in the rest of this blog post to help you decide where to buy dental insurance.
Want to get started now comparing dental plan options?
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The ACA Exchanges
Even though the Affordable Care Act (ACA) includes pediatric dental coverage among its essential health benefits, dental benefits for adults are not part of the ACA.[2]
You can get dental insurance through the ACA Marketplace, and that may be a convenient option for you, but it is important to keep the following in mind when it comes to ACA dental insurance:
Limited Enrollment Period: While you can get ACA marketplace dental coverage as part of a health insurance plan or as a stand-alone policy, you can only enroll in a Marketplace dental insurance plan through your state-based Marketplace or federally facilitated health insurance Exchange if you are also enrolling in a health insurance plan at the same time.[3]
ACA Subsidies May Not Apply: The ACA does not offer subsidies for adult dental insurance if it’s purchased as a standalone plan, however, if dental coverage is included in your ACA health plan (“embedded” coverage) and you have a single premium, you can still use the premium tax credit if you qualify.[4]
Getting embedded dental coverage may make sense for you if you qualify for subsidies, but it does result in a single higher deductible…
Embedded Dental – One Higher Deductible: The potential drawback of an embedded dental plan is that it may make it more difficult for you to reach your single deductible and utilize your dental benefits. Dental deductibles are typically quite a bit lower than medical deductibles, around $200.[5]
In 2019, an unsubsidized ACA Silver plan had an average deductible of $4,043.[6] For that reason, a stand-alone ACA Marketplace dental plan or a separate private dental insurance policy may make more sense.
Medicaid Coverage Gap: If you get your health insurance through Medicaid, you may have a dental benefits gap. Each state chooses whether or not to provide dental benefits for adult Medicaid recipients. Most states provide at least emergency dental services, however, less than half of states currently provide comprehensive adult dental coverage.[7]
For that reason, a private dental insurance policy may make sense if you’re a Medicaid recipient.
Quote and enroll in ACA health plans during open enrollment or a special enrollment period if you qualify.
Private Dental Insurance
Buying dental coverage in the private marketplace instead of an ACA Marketplace dental plan may offer you some key advantages, including:
Enroll Anytime: You can buy dental insurance anytime in the private marketplace – not just during the ACA’s open enrollment period or during a special enrollment period. The application and enrollment process is typically straightforward.
Easy to Shop + Compare Options: Unlike medical plans, dental benefits, coverage, and cost-sharing are relatively straightforward:
- You select an annual benefit maximum and deductible amount.
- Policies clearly state what percentage of costs they cover after you’ve paid your deductible based on the coverage level.
- Your policy pays their portion of covered services until the annual maximum has been reached. After that, you pay 100% of the costs of your dental services.
More Plan Selection: There may be more dental insurance companies and policy options in the private marketplace than there are in the state and federal exchanges, so it may be easier to find a plan that fits your specific needs, including network, cost-sharing, and benefits structure.
Get Dental Insurance Today!
Remember, you can apply for private dental insurance at any time. And just about anyone can benefit from regular visits to the dentist.
Dental coverage for the whole family means you can get kids started early with good oral hygiene habits.
Seniors on Medicare may need a private dental insurance policy since traditional Medicare doesn’t include dental benefits and regular dental care is still important (maybe even more so) for adults over 65.[8]
Some other basics about dental insurance include:
- Preventive dental care like teeth cleanings are often covered at 100%.
- Most applicants are accepted regardless of health history though rates are based on age and where you live, and exceptions or waiting periods may be instituted.
- With the exception of missing teeth, most policies cover previously existing conditions.
- Affordable premiums – Individual annual dental premiums typically range from $150 to $600, averaging around $300, or $25 per month depending on the benefits you select.[9]
- Affordable deductibles – Individual annual deductibles are typically less than $200.[10]
- Annual benefits maximums are typically less than $2,000.[11]
Ready to compare dental coverage costs and benefits? Getting a quote just takes a minute.
Summary + Next Steps
It may be convenient to purchase dental coverage at the same time that you’re enrolling in an ACA-qualifying medical plan, but you need to make sure the coverage makes sense for you.
Buying a dental insurance policy in the private dental insurance marketplace may offer some benefits:
- Apply anytime – you’re not restricted to the open enrollment period
- Having a separate policy rather than embedded coverage may make it easier for you to reach your annual deductible for dental benefits
- More options in the private dental insurance marketplace may make it easier to find a plan that fits your needs
You can get a dental insurance quote today. Or call (888) 855-6837 to speak with an insurance agent to discuss your options.
