Does Obamacare cover dental? It depends. The Affordable Care Act (ACA), or Obamacare, includes pediatric dental benefits as one of the essential health benefits for kids 18 and under. Learn more about dental insurance for kids and families.
Dental insurance is not an essential health benefit for adults, so insurers don’t have to offer adult dental coverage.
So, what are your options if you’re an adult looking for dental coverage? We’ll cover:
- Dental insurance for adults
- Levels of Obamacare dental coverage
- Private dental insurance
Plus, we’ll direct you where to find information about dental insurance for kids and seniors.
Where to Get Dental Insurance for Adults
Adults have a couple of options when it comes to dental insurance:
- ACA embedded or standalone coverage
- Private dental insurance
Dental coverage for those aged 18 to 26
As we’ve said, dental care is considered an ACA essential health benefit for those 18 or younger. However, the ACA extended dependent coverage of major medical health plans to those up to age 26, meaning you can stay on a parent’s health plan until you turn 26.
If your parent has embedded dental coverage under an ACA plan, you can continue to be covered until you turn 26. After that, you’ll have to find your own dental benefits.
If you’re an adult 18 years old or older and do not have dental benefits through a parent’s employer or ACA coverage, you can enroll in a private dental policy.
Dental coverage for kids under 18 and seniors
Learn more about dental coverage for kids including ACA dental.
Learn more about dental coverage for seniors and those on Medicare.
The ACA Marketplace
Some ACA Marketplace health insurance plans include dental coverage for adults, but you can also buy a standalone Obamacare adult dental plan. It’s important to note that you can’t buy an ACA dental plan unless you’re enrolling in a health plan at the same time.
If your Obamacare health plan includes dental benefits, your premium covers both health and dental benefits. If you choose a separate dental plan, you’ll pay a separate, additional premium.
It’s important to remember, if you purchase an ACA Marketplace health plan with dental coverage, dental expenses are usually only covered after your deductible is met. The average deductible is approximately $5,731 for individuals and $11,601 for families.
On the other hand, Obamacare subsidies can be used on health plans that include dental, but can’t be used on stand-alone plans.
Levels of ACA dental coverage: Obamacare dental plans are divided into either high or low coverage based on cost-sharing with the insurance company.
|Premiums||Copays + Deductible|
If you visit the dentist regularly for preventive care or expect that you’ll need a lot of dental care, a high coverage plan may be a better value since you’ll pay less when you receive care.
If you only visit the dentist when you have a concern or rarely have dental issues, a lower coverage plan may be a better value as you’ll pay less in premium each month.
Find the best dental insurance coverage for you.
Private Dental Insurance
There are a number of reasons to consider purchasing private insurance off the Marketplace, including:
- You have employer-sponsored health insurance, so you don’t have ACA-qualifying major medical insurance from the Obamacare Marketplace
- You need coverage before the open enrollment period
- You don’t find an ACA dental plan option to fit your needs
If you are a regular user of dental care, getting private dental coverage is probably a good idea.
Dental insurance plans include coverage for services like cleanings and exams, extractions, x-rays, fillings, crowns, bridges, and root canals – though not usually elective cosmetic procedures like teeth whitening or braces, implants or dental prostheses.
The costs of preventive care like routine exams, cleanings, x-rays and sealants may be
covered 100%, though you may pay an office copay.
And while policies may not include coverage for pre existing conditions (such as a broken or missing tooth), a pre existing condition may not necessarily disqualify you for coverage entirely, it just won’t apply to your pre existing condition.
Compare dental insurance costs and coverage now.
Summary + Next Steps
While Obamacare includes pediatric dental benefits as one of the 10 essential health benefits, in most states you’re not required to enroll your child in coverage, and dental care isn’t an essential health benefit for adults 18 and older.
You can buy health insurance plans that include dental coverage for adults or a stand alone dental insurance policy via the ACA Marketplace when you enroll in your major medical plan.
If you are not buying an ACA health plan, or need dental coverage outside of the Obamacare open enrollment period, dental insurance is available in the private market throughout the year, so you can get a quote and enroll anytime.
Find out whether to get your dental coverage from the ACA Exchange or the private market.