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Obamacare Dental Insurance FAQs

There is much to be learned about the Affordable Care Act, and Americans have many questions about how the health reform law works and its impact on them. A major topic is if and how Obamacare makes dental insurance plans more affordable. The truth is, the law has relatively minimal impact on dental coverage for adults. It does, however, aim to expand such benefits for children. The American Dental Association reports that nearly “8.7 million children could gain extensive dental coverage through the ACA by 2018.”

Below, we’ve answered many of the most common questions related to Obamacare as it relates to dental insurance.

Does the Affordable Care Act require Americans to purchase dental insurance?

No. While most Americans must buy health insurance in 2014 or face a tax penalty, there is no Obamacare mandate for dental insurance. Adults are not required to acquire it for themselves. Technically, they do not need to buy dental plans for their children, either. However, since pediatric dental and vision is one of the law’s 10 essential health benefit categories, it must be embedded into qualified health insurance plans unless it is offered as standalone coverage on health insurance exchanges.

Just because Americans aren’t required to buy dental plans doesn’t mean they should forego them. Dental insurance has been linked to access to preventive care, and preventive care such as regular exams and cleanings is key to oral health and overall health. Most basic dental plans cover preventive visits and services at 100 percent and can cost less than a dollar a day.

Will dental benefits be included in Obamacare health plans?

The Affordable Care Act does not include dental benefit requirements outside the pediatric dental and vision EHB. Health plan designs vary, so it is possible some major medical insurance sold on and off the exchanges will include dental benefits; however, it is not common.

Typically, individual and family medical plans do not cover oral surgery and other dental procedures unless such services are considered medical in nature. Before buying health insurance, read the fine print and be sure to ask any questions you have about the plan’s benefits. Always check with your dental and/or health insurance carrier to see if treatments, physicians, hospitals, etc. are covered before receiving care.

Will dental insurance be sold on the health insurance exchanges?

It depends on your state. Some state marketplaces will sell standalone dental plans for adults, as well as children, but just because dental coverage is sold on an exchange doesn’t mean consumers have to buy it on an exchange. Shop around on and off your state’s exchange to find the best rate and coverage for you and your family’s needs.

Contact an agent or broker, or consult a dentalinsurance.org sales specialist for help finding an affordable, trustworthy dental plan. You can also visit dentalinsurance.org for plan options and quote from multiple carriers; this service is free, takes seconds and requires no contact information. Simply enter your ZIP code, gender, desired effective date, and birthdate, as well as the genders and birthdates of your spouse and dependents, if applicable.

Does Obamacare allow children to stay on their parents’ dental insurance plans through age 26?

While the Affordable Care Act does not mandate that child eligibility for dental coverage be through age 26, many dental carriers have opted to increase the dependent age limit for their plans. This practice is strictly optional. Check with your current dental plan or the dental plans you are considering. Again, work directly with the carrier or an agent/broker to find the best fit for you and your family.

Who is considered a child when it comes to Obamacare’s pediatric dental and vision essential health benefit?

Children under age 19 are eligible for pediatric services.

If the pediatric dental and vision EHB in my state is sold separately, do I have to buy it for my child(ren)?

No. There is no requirement that parents or guardians acquire standalone pediatric dental and vision EHB plans for their dependents, if they buy on their state’s exchange. Those who buy health plans through an employer, as well as those who buy off the exchange, are required to buy the pediatric dental and vision EHB, according to the American Dental Association’s interpretation of the law.

What is covered by the pediatric dental and vision essential health benefit?

These benefits will vary. Each state selected a benchmark plan, and all plans must include the same basic benefits. Some may offer more. According to the American Dental Association, “all states except Utah (which is offering only preventive dental services) have chosen either the state’s Children’s Health Insurance Program plan or the MetLife High Option plan from the Federal Employee Dental and Vision Insurance Program as their benchmark plan.”

Plans with embedded dental benefits may include common, relatively low-cost preventive, diagnostic and emergency procedures, while a CHIP program may have more robust benefits including medically necessary orthodontia. Read “How Obamacare Will Impact Kids’ Dental Access” for more information about the pediatric dental and vision EHB.

Are grandfathered plans required to include the pediatric dental and vision EHB?

No, health plans granted grandfathered status are not subject to the Affordable Care Act’s essential health benefits categories or other provisions.

Are there Obamacare tax credits and subsidies for dental insurance premiums?

No. This assistance applies specifically to health insurance plans purchased from state-based and federally funded exchanges, and eligibility is determined by household income.



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