Dental Insurance

Is Dental Insurance Required?

Under the ACA health care law, dental insurance is treated differently for adults and children 18 and under.

  • Dental coverage for children is an essential health benefit. This means if you’re getting health coverage for someone 18 or younger, dental coverage must be available for your child either as part of a health plan or as a stand-alone plan. Note: While dental coverage for children must be available to you, you don’t have to buy it.
  • Dental coverage isn’t an essential health benefit for adults. Insurers don’t have to offer adult dental coverage.

The age limit varies among states from 18 to 21 depending on the requirement of a specific state. In Marketplace, pediatric dental policies typically do not have a waiting period for benefits while adult dental policies often have 6 to 12 months’ waiting period except for diagnostic & preventive services, which is covered on the effective date.

You may purchase dental coverage in two ways:

Dental coverage is included in health plans. If a health plan includes dental coverage, you’ll pay one monthly premium for both. However, some health plans including dental coverage offer dental benefits after you meet the deductible amount. You should carefully consider your dental care needs before purchasing this type of plans.

Separate, stand-alone dental plans.  You may want this if the health coverage you choose doesn’t include dental coverage or subject to a high deductible amount.

You can buy a dental plan through the federal Marketplace only when you enroll in a health plan at the same time. If you’re already enrolled in a Marketplace plan, you can’t add on dental coverage. You have to wait until the next Open Enrollment Period to change plans. If you qualify for a Special Enrollment Period, you can get dental coverage with your new health plan.

Some insurance carriers offer dental coverage off-exchange year long. So you can purchase a dental plan outside Open Enrollment Period.