Is dental insurance included in the Affordable Care Act? In short, yes! As long as it is purchased either as part of a comprehensive health insurance package or in addition to health insurance as a stand-alone plan, you can find dental coverage through the ACA.
Don’t rush off to shop just yet, though! When it comes to insurance, things are never quite as easy as a simple yes or no, right? There’s more to it, of course, but don’t worry. Below, we’ll explore some of the nuances of the ACA and figure out exactly how dental insurance is included in the Affordable Care Act.
What Is the ACA?
You’ve probably heard of the Patient Protection and Affordable Care Act, though you might know it better as the ACA, Affordable Care Act, or Obamacare. Whatever name you use, it all refers to a particular healthcare reform and its subsequent amendments, originally signed into law by President Barack Obama in 2010.
When it was implemented, the ACA’s goals were to reform the private insurance market, lower the cost of medical care, and ensure that more Americans could get coverage. It expanded Medicaid to low-income workers and children, ensured that women would not be charged more for insurance, and provided protections to those with preexisting conditions.
According to the White House, the ACA has given nearly 31 million Americans access to health care coverage that they might not have been able to get otherwise.
Is Dental Insurance Included in the Affordable Care Act?
Yes! But because dental coverage is not considered an essential health benefit for adults, not every insurer will offer a dental coverage package. You can find dental coverage options in the Marketplace, but you must purchase it in one of two ways:
Buying a comprehensive health care package that includes dental coverage. With this option, you’ll be paying one premium. This may appear more expensive because both health and dental are accounted for in the amount, but keep in mind that these bundles could be cheaper overall than the second option.
A separate, stand-alone dental plan can be purchased, but only alongside a health plan. You will be paying two premiums in this instance, but you have greater freedom in choosing the dental coverage you want.
Dental Plan Categories
In addition to deciding whether you want to bundle or buy two stand-alone plans, you will have to consider which category of dental plan you’d like. The ACA offers two types of dental coverage:
A High Coverage Level dental plan has higher premiums (that’s your monthly fees) but lower copays (a cost paid at the time of visit), and deductibles, (an amount you must reach before insurance will kick in and cover services). In short, a high-level plan will cost more every month but less when you actually visit a dentist. This is a better option if you and your family need frequent dental care throughout the year.
A Low Coverage Level plan is just the opposite: lower premiums with higher copayments and deductibles. Here, you’re paying less every month, but more when you visit the dentist. If you and your family only go to the dentist for basic things like twice-yearly cleanings, a low coverage plan may be more cost-effective.
Dental Insurance for Children
Per the ACA’s website, dental coverage is an essential health benefit for children. Insurers are required to include a dental coverage option in all packages offered to someone 18 or younger, either as an extension of health insurance or as a stand-alone plan. At the same time, while dental coverage will always be offered, you are not required to buy it.
How to Get Covered
Now that you know how dental insurance is included in the Affordable Care Act, it’s time to consider getting covered. Whether you’re specifically looking to get private insurance or applying for coverage through Medicaid or CHIP, you’re going to start in one of two places: either the federal government’s Health Insurance Marketplace or your state’s Marketplace.
Depending on what you’re shopping for, there may be some restrictions, like enrollment periods or income eligibility.
In order to apply for Marketplace coverage, you must be within an active enrollment period. Those come in two types:
Open enrollment starts and ends on roughly the same dates every year. It usually begins November 1st and typically ends in mid-December or January, depending on the state you live in. Because of the ongoing Coronavirus emergency, however, deadlines are being extended. In 2021, open enrollment was extended through August 15th.
Special enrollment periods are granted to individuals who experience particular life events such as marriage, moving to a new state, having a baby, or losing other coverage. You can learn more about special enrollment periods on the healthcare.gov website.
Medicaid & CHIP
If you qualify, you can enroll in Medicaid or the Children’s Health Insurance Program (CHIP) at any time. Keep in mind that while children are guaranteed dental coverage through Medicaid and CHIP, adult dental care coverage rules are different. What you receive as an adult beneficiary will depend on the state you live in.
You can apply for Medicaid and CHIP in two ways:
Fill out an application through the Health Insurance Marketplace, a process you can do by creating an account on healthcare.gov.
Apply directly through your state Medicaid agency. This page on healthcare.gov has a dropdown menu that will allow you to select your state and take you directly to its Medicaid page.
What If I’m Not Eligible for the ACA?
If you are not eligible for any of the ACA’s offerings, consider a dental savings plan. Unlike traditional insurance, which directly covers a portion of the cost of dental services, a dental savings plan provides a discount on dental services. While you will never have the cost of a procedure fully covered by a dental savings plan, a dental savings plan’s lower annual fees, lack of deductible, and copay means it might wind up being a more affordable option for you.
While the ACA doesn't guarantee dental insurance, it does provide avenues for getting the coverage you need. Whether you're applying for Medicaid or market insurance, there's a lot to consider, but it doesn't need to be overwhelming! Educating yourself with guides like this one will make picking insurance far easier down the road.