Dental insurance for adults is not part of Obamacare. However, as you may know, the Affordable Care Act includes pediatric dental coverage among its 10 essential health benefits. That means dental coverage must be made available on state-based and federally facilitated exchanges to children ages 18 and younger. These benefits may be embedded in health insurance plans or be made available as standalone plans. Despite this provision, adults are not required to purchase dental benefits for their dependents.
Nonetheless, it can be wise for individuals and families to buy dental insurance coverage. Good health includes good oral health. Along with good oral hygiene, the American Dental Association says that regular dental exams can prevent most dental disease.1 Dental benefits can help reduce what you pay out of pocket for dental care, and some plans cover preventive services including professional cleanings and exams at 100 percent.
So, where should you buy dental insurance? Should you shop the private marketplace or your state-based or federally facilitated health insurance exchange? While a state or federal exchange may sound convenient, it is important to keep the following in mind:
- You can only enroll in a dental insurance plan through your state-based or federally facilitated health insurance exchange if you are also enrolling in a health insurance plan
- Obamacare does not provide subsidies for adult dental insurance, and not all pediatric dental premiums will be eligible for subsidies.
- Medicaid dental benefits vary widely by state—as of June 2015, 15 states had nearly comprehensive coverage, 16 states and the District of Columbia offered limited coverage, 14 states covered only emergency dental care, and five states did not offer adult dental coverage2
Why buy dental insurance away from the exchanges?
Enrolling in a standalone dental plan in the private marketplace—either through a health insurance agent or website such as healthedeals.com—may have some advantages such as access to:
You can buy dental insurance in the private marketplace anytime of the year—not just during Obamacare open enrollment.
Clearly defined dental benefits that fit your needs
Sometimes exchange-based dental plans are embedded in health insurance plans. Embedded dental benefits can be mysterious, or even forgotten about. Furthermore, depending on the health insurance plan, dental care may be subject to the medical deductible and out-of-pocket maximum. Financially, this may or may not be the best deal for your family, depending on your health care and dental care needs. What you get is what you get, which leads us to the next advantage of shopping the private marketplace:
A broader plan selection
There tend to be more dental insurance plan options in the private marketplace than there are through the state and federal exchanges—as a matter of fact, not all exchanges even offer dental insurance plans for adults.
One size does not fit all. Having more options allows you to carefully select dental benefits that make sense for you and your family—dental benefits you will use. You can make your choice based on premium as well as factors such as deductible, coinsurance, copays, and network providers. For example, if you have few dental needs and simply want to take advantage of robust preventive and basic benefits, you can typically find a dental plan with a lower premium; if you tend to need more dental work, you may find a plan with more robust major care benefits but at a higher premium.
- Dental coverage for the whole family – Depending on the dental plan selection available through your state-based or federally facilitated exchange, you may only be able to purchase pediatric dental benefits or, due to a smaller selection of plan options, you may be challenged to find a dental plan that meets your entire family’s needs. This may mean mom and dad skip dental or have different dental plans. In the private marketplace, once you find dental coverage that makes sense for your whole family, you can add dependents and keep things simple with one dental plan and one dental premium.
- Valuable added discounts – Many dental plans sold in the private marketplace provide enrollees with access to special hearing-, orthodontia- and vision-related discounts or services such as dental tourism, in which companies will help you arrange for reduced-cost treatment in other countries. These added discounts and services can help reduce overall health care costs for many individuals and families.
If you need help selecting the right dental insurance plan for your family, call 866-278-1464 to talk to an IHC representative.