Does Obamacare Have Dental Insurance?

The Affordable Care Act (ACA) primarily addresses dental care with different provisions for children and adults. Pediatric dental coverage is an Essential Health Benefit (EHB) under the ACA, meaning it must be available for individuals up to age 19. Adult dental coverage, however, is not considered an EHB and is typically purchased separately. Both options are accessible through the ACA marketplace.

Pediatric Dental Coverage

Pediatric dental services are an Essential Health Benefit (EHB) under the Affordable Care Act for individuals aged 18 and younger. All ACA-compliant health plans in the individual and small group markets must ensure pediatric dental coverage is available. Insurers provide this benefit either embedded within a comprehensive health plan or through a separate, stand-alone dental plan (SADP). If a marketplace health plan does not include pediatric dental coverage, a SADP must be available for purchase alongside it.

For children covered by a stand-alone dental plan through the ACA marketplace, specific out-of-pocket limits are designed to protect families from excessive costs. As of 2024, the annual out-of-pocket maximum for pediatric dental services is $400 for one child and $800 for multiple children covered by the same plan. Once this limit is reached, the plan pays 100% of remaining covered services for the rest of the plan year. These plans generally do not impose annual or lifetime maximums for covered pediatric dental benefits.

Adult Dental Coverage Options

Adult dental coverage is not considered an Essential Health Benefit under the Affordable Care Act. Standard health insurance plans available through the ACA marketplace are not required to include dental benefits for adults. Adults typically acquire dental coverage by purchasing separate stand-alone dental plans (SADPs) through the marketplace.

These stand-alone dental plans often cover a range of services, including routine preventive care like cleanings and exams, basic procedures such as fillings, and major services like crowns or bridges. SADPs involve common cost-sharing elements, including monthly premiums, deductibles that must be met before the plan begins to pay, and co-insurance or co-payments for services. While financial assistance, such as premium tax credits, may be available for health plans, these subsidies generally do not apply to the premiums of stand-alone dental plans.

Accessing Dental Plans Through the Marketplace

Individuals seeking dental coverage can explore options through the Health Insurance Marketplace, primarily accessed via Healthcare.gov or their state’s specific marketplace website. Users can filter or search for “dental” or “stand-alone dental plans” to view available options. In most cases, you cannot purchase a stand-alone dental plan through the marketplace unless you are simultaneously enrolling in a health plan.

When comparing dental plans, evaluate key factors such as the monthly premium, deductible, co-payments for services, and the annual maximum benefit. Plans are often categorized as “high option” or “low option,” where high-option plans typically have higher premiums but lower out-of-pocket costs like co-payments and deductibles, while low-option plans have lower premiums but higher cost-sharing when services are used.