Dental Insurance

Good oral health is important for your overall health – dental insurance can help!
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What Does Dental Insurance Cover?

Dental plans typically cover four categories of services: preventive, diagnostic, basic and major care.

The list below includes examples and is not a complete list of coverages, exclusions and limitations.

Individual plans vary, so you’ll want to read the plan details closely to validate the coverage and benefits you’ve selected and limitations and exclusions that apply.

What Dental Insurance Covers
  • Cleanings + checkups

  • Extractions

  • X-rays

  • Fillings

  • Crowns, bridges + root canals

What Dental Insurance Does Not Cover
  • Anything after the plan’s annual maximum benefit amount has been reached

  • Elective cosmetic procedures (e.g., tooth-whitening)

  • Orthodontics (e.g., braces)

  • Implants

  • Prosthodontics (dental prostheses)

  • Oral care related to a medical condition (e.g., TMJ)

  • Prescription drugs + analgesia pre-medication

Dental Coverage is an ACA-Mandated Essential Health Benefit for Kids

Pediatric services, including oral and vision care, are part of the 10 essential health benefits for children 18 years of age and under. Adults, however, must obtain dental insurance if they want coverage and don’t have it through an employer.

Pros and Cons of Dental Insurance

  • Guaranteed issue – All applicants aged 18 to 99 are accepted regardless of health history (however, rates are based on age and location).
  • Covers pre-existing conditions – With the exception of missing teeth in some cases.
  • Apply year-round – There is no official open enrollment period and, in most cases, coverage begins the next day after you enroll online.
  • Flexibility – An indemnity plan affords you more provider options. A PPO plan can help lower your out-of-pocket expenses by using an in-network provider. Either way, it’s your choice.
  • Options for every budget – Varying amounts of coverage range from 50% to 100%, which means you can find a plan with the level of coverage you need at the right monthly premium rate for your budget.
  • Low deductibles – With annual deductibles generally around $50,[1] most people will be able to access their dental plan’s full benefits without paying a significant amount out of pocket first.
  • Waiting periods – You may have to put off dental services until you’ve had your plan for 6-12 months to take advantage of your benefits for certain services like fillings and root canals.
  • Calendar-year maximums – Unlike ACA plans that don’t have annual maximums for essential health benefits, dental plans have annual caps on how much the plan will pay per year (e.g., $1,000). Even with dental insurance, you will be responsible for the costs of services that exceed the annual limit.
  • Not ACA-qualifying major medical coverage – Dental insurance is a form of supplemental health insurance, not ACA-qualifying major medical coverage.

Find Answers to Dental Insurance Questions

There is no official enrollment period for dental insurance away from the ACA Exchange, so you may apply for coverage at any time. Coverage typically begins the next day after online enrollment. You may only enroll in a dental plan from the ACA Exchange during the annual open enrollment period (or a special enrollment period, if you qualify) when you enroll in your medical policy.[2]
This type of supplemental insurance is designed to cover dental care expenses. Dental insurance can be offered as part of a medical insurance policy, or as a stand-alone plan. A dental insurance plan may be setup as an indemnity plan, a participating provider organization (PPO), or a health maintenance organization (HMO) plan.[3] Dental insurance can help you pay for costs related to maintaining good oral health, which studies indicate can positively impact your overall health.[4]
No, dental plans are not qualified health plans under the terms of the ACA. However, the Affordable Care Act (ACA) lists dental coverage as an essential health benefit for children under age 18.[5] This means if you purchase an ACA-compliant health insurance plan, dental coverage must be available for your child as either part of that plan or as a separate dental plan. You also may use premium tax credits through to help pay for pediatric dental insurance premiums if your health insurance policy does not include dental coverage.[6] The ACA does not consider dental coverage to be an essential health benefit for adults 18 and over, nor require insurers to offer adult dental coverage.[7]