What the ACA requires for adults and children
We know that the Affordable Care Act’s individual shared responsibility provision requires most Americans to have minimum essential coverage—health plans that meet the law’s requirements. But what about dental insurance?
Pediatric services, including oral and vision care, are among the ACA’s 10 essential health benefits—a set of healthcare services categories that must be included in all Obamacare health insurance plans.1 As such, parents with children 18 years of age and younger may:
- Purchase dental coverage as part of their child’s Obamacare plan if their medical carrier offers it
- Or, obtain it through a qualified standalone dental plan.
So, the answer is pretty clear if you have a child under 19. But what about adults? Do they need dental insurance in addition to an Obamacare plan?
Obamacare dental for adults
Adult dental coverage is not among the ACA’s essential health benefits. And while the healthcare reform law neither requires health insurers to provide adult dental benefits nor does it require adults to buy them, a dental plan can be a smart addition to your Obamacare coverage.
Why should I buy dental insurance?
For many people, Regardless of your age, preventive dental exams and cleanings are an important part of maintaining healthy teeth and gums.2,3 And, if you have dental benefits, studies show you are more likely to visit the dentist for these services and other dental care.4
While the average per-patient dental expense remained relatively stable from 2008 to 2011, the cost of dental care can have a significant impact on your budget. For seniors, the average expenses were $767 per year, and for people under the age of 65, including children, the average expense was almost $650.5
Dental plans can help reduce the financial impact of dental expenses through benefits that reduce the cost of many services, from preventive to major care.
What are the different types of dental plans?
Individual dental plans fall into two categories: discount plans or insured plans.
1. Dental discount plans
Discount plans are not actually insurance plans. They provide discounts off the retail charge rate at participating dentists.
While discount plans are often less expensive than dental insurance, you will be responsible for paying the dentist the discounted bill out of your own pocket, with no assistance from an insurance company. Discount plans generally run between $9.95 per month and $15.95 per month for single coverage, with most requiring a full-year, up-front payment.6
2. Dental insurance plans
Most insured dental plans offer coverage for preventive care, often with no out-of-pocket cost to the patient when using a network provider, and may offer coverage for fillings, crowns, root canals and other dental services. Some dental plans may even include vision benefits.
The cost of an insured dental plan will vary depending on the home ZIP code of the insured person and the level of benefits covered. While insured dental plans are often more expensive than discount plans, their premiums begin at less than $20 per month for a single plan, depending on the benefit level selected.7
Can I buy dental insurance from an ACA exchange?
Most people get dental coverage through an employer. If you do not have that option, you can purchase an individual dental plan on your own one of the following ways:
- Through a state-based or federally facilitated health insurance exchange – Some insurance companies sell stand-alone dental plans through the ACA’s government exchanges, but this is not necessarily the case in every region. Your selection may be limited.
- In the private market – You can also buy an individual dental insurance plan through a licensed health insurance producer (i.e., agent, broker, adviser) or a private-market health insurance exchange such as www.healthedeals.com and www.dentalinsurance.org.
When shopping for dental benefits, compare your coverage options and look for plans that come with additional discounts and benefits you may find useful.
If you have dental and vision insurance questions or need help selecting a plan, call the number at the top of your screen to speak with a licensed health insurance producer today.
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