Does the Affordable Care Act Cover Dental Care/Insurance?

Does the Affordable Care Act Cover Dental Care/Insurance?
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Does the Affordable Care Act Cover Dental Care/Insurance?Clinical Content Reviewed by Dr. Jay Khorsandi, DDS
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Table of Contents

  1. Dental Insurance & Care in the US
  2. ACA Coverage of Dental Insurance
  3. Dental Insurance Considerations
  4. Getting Your Child Dental Insurance
  5. ACA Open Enrollment
  6. References

Since 2016, the Affordable Care Act (ACA) has provided dental insurance options through mandated health insurance marketplaces, either as stand-alone plans or combined with health insurance. Children are required to have dental insurance coverage, but adults are not.

Access to dental insurance is correlated with greater use of dental services, which can improve health outcomes across the country.

Access to Dental Insurance & Care in the United States

The Affordable Care Act (ACA), sometimes colloquially called Obamacare, was passed in 2010. This law reformed health insurance in the United States by creating online marketplaces where consumers could compare the cost and benefits in plans, providing income-based adjustments to cost through tax credits and requiring that the majority of American adults have health insurance coverage so they can manage their preventative care.

The ACA did not initially provide dental plans, but in 2016, dental coverage was offered through health insurance marketplaces. These offerings can be found both at the federal HealthCare.gov site and through state-based marketplaces.

Like standard health insurance, the dental plans offered through the ACA marketplaces have adjustable prices based on your income. Unlike standard health insurance plans, however, dental plans are not mandated for US adults.

Updates to the ACA require children to have dental insurance coverage, even if their parents do not. For adults, dental plans must be made available through the marketplace, but you do not have to purchase one for yourself.

Dental insurance is an important part of helping you manage preventative healthcare with regular checkups and cleanings. The Centers for Disease Control and Prevention (CDC) report that one in four adults in the US has untreated tooth decay, which can severely impact physical health and mental wellbeing.

ACA Coverage of Dental Insurance

There are two ways you can get dental insurance through an ACA marketplace.

  1. Health plans that include dental: When you log onto your health insurance marketplace to view healthcare options, you can see which standard plans offer attached dental insurance. These may be more expensive due to combining two types of health plans, but some people prefer to use one company to cover all their healthcare needs. Paying one premium to one company may also be financially simpler.
  2. Stand-alone dental plans: If your health insurance does not cover dental treatment, and you like the plan, you can find separate dental insurance plans through the marketplace too. This will be a separate premium payment each month, but the premium will be adjusted based on your income, just like your standard health insurance.

Once you determine which approach works best for your oral health needs, you can consider the two basic dental plan categories.

  1. High: If you pay a higher monthly premium for your dental insurance, you will have lower copayments and deductibles. Those who have more oral health needs or who are at risk of needing more oral health treatments may benefit from this type of plan.
  2. Low: Paying a lower monthly premium for dental insurance means you will pay higher copays and have a higher premium for your visits. If you only need basic oral health care like an annual cleaning and examination, this will likely be the best option for you.

The ACA marketplace should allow you to compare plan levels, costs, and listed benefits, so you can decide which type of plan suits you the best. For example, if you need or want extensive orthodontic treatment, you may benefit from paying more each month but getting better coverage for braces and retainers.

Since dental insurance is not mandated by the ACA like health insurance is, you will not be penalized for failing to purchase this insurance. If you have dental insurance separate from your standard health insurance, you will also not receive a tax form to file with your annual taxes. However, if you have unreimbursed dental health expenses at the end of the year, you can claim these as a tax deduction.

The Affordable Care Act for dental insurance coverage applies to anyone under the age of 19, so even if your child does not consider themselves a child, HealthCare.gov does.

Considerations Before You Choose a Dental Insurance Plan

Now that you have considered your general oral health and financial needs, here are some other questions to consider as you purchase a dental insurance plan:

  • How does the plan treat referrals to dental specialists who are not your primary dentist? Are there in-network specialists?
  • How far do you have to travel to find a dentist who accepts this insurance plan?
  • Is there an annual limit to what your adult dental insurance plan will cover, and will you need more treatment than that?
  • Approximately how much are the copays for routine care like x-rays, dental cleanings, sealants, and fluoride treatments?
  • How much coverage does the plan offer for more intensive treatment like root canals, fillings, and oral surgery, including extractions?
  • How much coverage does the plan offer for dentures, crowns, fixed bridges, implants, and other treatments for gum and jaw disease?
  • How much coverage is provided for “nonessential” options like orthodontics?
  • Is there a waiting period before the plan covers certain treatments you might need?
  • Does the plan cover your children? What dental treatment options are covered for children?

Getting Your Child Dental Insurance

Adults are not required to purchase dental insurance, but children must have dental coverage, according to the ACA. “Children” are considered anyone 18 and younger. Like adult dental insurance, children’s dental insurance can either be combined with their healthcare plan or purchased separately.

A study on children’s health insurance through the ACA marketplace was published in 2018. The study noted that children in lower income families typically had less access to dental care and therefore poorer health outcomes. Since the ACA offered lower cost dental insurance coverage using pediatric stand-alone dental plans (SADPs), the study examined whether there were improvements in children from lower income families.

SADPs were significantly less expensive than standard health maintenance organizations (HMOs) and preferred provider organizations (PPOs). However, there was a huge range of premium costs with SADPs through the ACA marketplace. The researchers concluded that, so far, the offerings may provide limited help for children in lower income families since there aren’t more options for dental insurance to create more competition.

Another study published the same year suggested a correlation between better access to dental insurance and maintaining better oral health later in life. Looking at two groups of young adults (27-year-old and 25-year-old adults), the researchers found that 25-year-old adults were 8 percentage points more likely to have private dental insurance coverage within three years after the ACA mandate compared to the slightly older age group. While the researchers noted that this did not necessarily translate to greater use of dental services, the assumption was that access to dental insurance would mean greater use of preventative care, which can improve health outcomes.

Keep Track of When ACA Enrollment Opens

Although the ACA is over 10 years old, the law is still being contested at the state level, with coverage and enrollment options varying based on where you live. Federally, the enrollment period has shrunk to just six weeks at the end of each year, so you will need to be diligent about when your marketplace opens for new enrollments. Ultimately, dental insurance can help you get the oral healthcare you need.

References

What Is the Affordable Care Act? US Department of Health and Human Services (HHS.gov). Date fetched: June 9, 2021.

Appendix Three: Dental Care Under the Affordable Care Act. Delaware Health and Social Services (DHSS Delaware). Date fetched: June 9, 2021.

Can I Get Dental Insurance with Obamacare? (August 2020). Investopedia. Date fetched: June 9, 2021.

Adult Oral Health. (December 2020). Centers for Disease Control and Prevention (CDC). Date fetched: June 9, 2021.

Dental Coverage in the Marketplace. Healthcare.gov. Date fetched: June 9, 2021.

Are Medical Expenses Tax Deductible? (May 2021). Intuit TurboTax. Date fetched: June 9, 2021.

Affordable Care Act Marketplace. American Dental Association (ADA). Date fetched: June 9, 2021.

Factors Affecting the Affordable Care Act Marketplace Stand-Alone Pediatric Dental Plan Premiums. (September 2018). Journal of Public Health Dentistry.

The Impact of the Affordable Care Act’s Dependent Coverage Mandate on Use of Dental Treatments and Preventative Services. (September 2018). Medical Care Journal.

Disclaimer: This article is intended to promote understanding of and knowledge about general oral health topics. It is not intended to serve as dental or other professional health advice and is not intended to be used for diagnosis or treatment of any condition or symptom. You should consult a dentist or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.

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