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Dental insurance, for the most part, isn’t covered under ObamaCare (the Affordable Care Act). However, children’s dental coverage is a required benefit included on all ACA compliant plans and cost assistance can be applied to any Marketplace plan that includes dental.

Although Dental isn’t a required benefit of the Affordable Care Act, it is certainly an important aspect of health and wellness and therefore we thought it would be appropriate to discuss dentistry facts, dental insurance, and how the new healthcare law affects dental coverage.

Dental Coverage, Rights and Cost Sharing

Here is a quick summary of what you need to know about dental, your rights, and how cost sharing works on dental plans:

  • A child must be offered dental, but you don’t have to take it.
  • If you have dental coverage through the Marketplace it will typically have a maximum of $700 for a child or $1, 400 for a family.
  • Adults don’t have to be offered dental. However, many Marketplace plans offer dental as part of the plan, or as a standalone. You can’t cancel dental that is part of your plan, so keep this in mind.
  • If dental is part of your plan, you can still use cost assistance to lower your plan costs.
  • Even with cost assistance, when you reach the maximum, you typically pay 100% of the costs for dental work. This is the opposite of health insurance under the ACA where you pay 0% after your maximum. So don’t be confused by that.
  • Oral surgery may be covered by medical insurance in some specific cases, but generally it doesn’t cover non-medically necessary procedures.
  • Dental works best for routine care, it is uncommon to find any insurance that covers major dental work past a certain dollar amount. (“The Dental Gap”?)

Adult Dental Coverage and the Marketplace

Some marketplace plans include dental coverage. If you decide you want dental coverage and your plan doesn’t offer it, you can enroll in a separate, stand-alone dental plan after you enroll in marketplace coverage. Private dental plans can be obtained both on and off the marketplace.

Can I Get Cost Assistance on Dental Coverage?

Generally cost assistance only applies to major medical coverage and not dental plans. However if you get a marketplace plan that includes dental insurance, it will only have one premium which Premium Tax credits can be applied to. You cannot apply Tax Credits to a stand-alone dental plan. CHIP includes dental insurance.

Child Dental Coverage

All plans offered to children must include dental coverage as an essential benefit. This means if you’re getting coverage for someone 18 or younger, dental coverage must be available as part of a health plan or as a stand-alone plan. While it must be available to you, you don’t have to buy it.

Rejecting child dental coverage won’t result in your child not having minimum essential coverage, and you won’t pay the fee.



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