Is Pediatric Dental Coverage Required Under Obamacare?

Jenifer Dorsey
2018-11-06 February 25th, 2016 |
Read time: 9 minutes

Consumers have had a lot to learn under the Affordable Care Act—especially since 2014, when the individual shared responsibility provision took effect and required most Americans to obtain health insurance.

Following the third Obamacare open enrollment period, we all seem to understand the law a little more and what it does and does not require. However, our education is ongoing, and there are still some uncertainties.

One common question: Does Obamacare mandate that kids have dental insurance?

Not exactly, but the law does require coverage be made available to kids. These are the basics when it comes to the Affordable Care Act and children’s dental coverage1:

  1. Pediatric services, including oral and vision care are among the ACA’s 10 essential health benefits— also known as EHBs, these are a set of healthcare services categories that must be included in all major medical health insurance plans sold through the state-based and federally facilitated exchanges as well as in the private market.
  2. Because it is an essential health benefit, dental coverage must be available to children 18 and younger as part of a health insurance plan or as a standalone plan.
  3. Parents are not required to buy dental insurance for their kids—it is optional for everyone and there is no penalty for going without it; however, as mentioned above, it may be part of a health insurance plan.

What are the Obamacare pediatric dental benefits?

Pediatric dental benefits will look a bit different from state to state. Each state selects an EHB benchmark plan, which sets the standard for all health insurance plans sold within that state—all other plans must be substantially equal to the benchmark.2

If the state’s benchmark plan doesn’t include pediatric dental benefits, the Federal Employees Dental and Vision Insurance Program with the largest national enrollment or the state’s CHIP program will serve as the benchmark for this category.

Check with your plan or the plan you are considering for detailed information about its pediatric dental benefits.

What do you do if your child’s Obamacare plan doesn’t include pediatric dental benefits?

If you are not certain, then contact the health insurance company and verify that this is, indeed, the case. You will then want to purchase a standalone dental plan for your child—and, possibly, your entire family.

Can I buy dental insurance outside open enrollment?

Yes. Dental plans are available year-round, which means you can buy one anytime, not just during open enrollment. You can buy individual and family dental plans from:

  • Health insurance producers, including the certified advisors available by calling the number at the top of your screen
  • Websites such as www.healthedeals.com and www.dentalinsurance.org
  • Your state-based or federally facilitated exchange
  • Insurance companies that sell dental plans in the private market

There are many dental plan designs on the market, and they can often be customized to meet your household and dental care needs.

Why would my child need dental insurance?

Tooth decay is the most common chronic disease among U.S. children, and the CDC reports that more than 40 percent of kids have it by the time they reach kindergarten.3 Preventive dental exams and cleanings are an important part of maintaining healthy teeth and gums at all stages of life.4,5 Research shows that people with dental insurance are more likely to visit the dentist for these services and other dental care.6

Dental plans can help lower what you pay out of pocket for your child’s dental care—as well as your own, if you also have dental coverage. While benefits vary by plan, dental plans typically include coverage for the following types of care7:

  • Preventive – e.g., routine exams, professional cleanings, X-rays, sealants for certain age groups
  • Basic – e.g., fillings, extractions, root canals, treatment for gum disease
  • Major – e.g., crowns, bridges, inlays, dentures

Plus, some dental plans offer an optional orthodontic discount program.

If you have questions about dental benefits for your family or need assistance in selecting a plan, please call the number at the top of your screen to speak with a certified advisor.

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Originally Published On February 25th, 2016

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