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Do I need dental insurance for ObamaCare?

Here's what you need to know...
  • Adults are not required to purchase dental insurance under Obamacare.
  • If you have children, your insurance provider must offer you dental insurance for your children. This includes providers who are part of the Marketplace as well as those who operate independently.
  • You do not have to purchase dental insurance for your children, even though it has to be offered to you.
  • Dental insurance can cover preventive care and other types of dental treatment. Dental care can also be paid for out-of-pocket.

Under Obamacare, dental insurance is not a required component of insurance for adults, but it may be offered through your Marketplace plan for an additional amount. You must be offered coverage for any children under 18, but you’re not obligated to sign up for it. If you’re interested in obtaining insurance, it’s a smart idea to shop around for the right dental insurance plan for you. Compare health insurance rates now by using our FREE tool above!

What Would Dental Insurance Cover?

Dental care is usually broken up into three categories:

  1. Preventive care- Most dental insurance plans pay for preventive care in full, though you need to check with your particular provider to make sure.
  2. Basic treatments- Basic treatments, like cavity treatments and root canals, are usually partially paid for by your insurance company.
  3. Major treatments- The cost of major treatments, like crowns and dentures, are also shared by the patient and the insurance company.

In general, an insurance company will pay for a higher percentage of your preventive and basic treatments in comparison to major treatments. For example, your insurance may cover, the entire cost of your X-ray, 75% of the cost of your root canal, and only 50% of the cost of your dentures.

The Different Types of Dental Insurance

When comparing your options, you’ll generally find two types of insurance:

  1. A higher coverage plan will charge higher monthly premiums. Since you’re paying more up front, you’ll benefit from having lower copayments and deductibles.
  2. A lower coverage plan will charge lower premiums. You’ll make up for that by paying higher copayments and higher deductibles.

If you choose to purchase a stand-alone plan, you can buy:

  1. A preferred provider plan. This plan encourages you to use certain providers. They offer services at a discount when you use the network providers.
  2. A fee for service plan. This plan pays your provider according to a fee schedule. You can usually visit any provider.
  3. A dental health maintenance organization pre-paid plan. Dentists who have a contract with your insurance company are paid a set fee to care for you.

In some states, you can obtain dental insurance through Medicaid if you qualify. In most states, children up to age 19 (and sometimes older) can receive dental coverage through CHIP.

How can You Sign Up for Dental Insurance?

When you sign up for your Marketplace plan, you can also sign up for a dental plan. You must sign up for both at the same time. If your employer offers dental insurance, you can work with your Human Resources department to sign up for coverage. You may only be able to do so during an open enrollment period. You can also purchase a stand-alone dental plan at any time on your own.

What is Cost Assistance?

You may be eligible for cost assistance through ObamaCare. Depending on your income and cost of insurance, you may be eligible to receive tax credits or subsidies to assist with your out-of-pocket costs.

What is the “Dental Gap?”

Most insurance policies will cap your coverage at a certain amount. If you get insurance through the Marketplace, your cap will be $700 per child and $1,400 for your family. Caps set by stand-alone policies will vary.

Once you’ve hit your cap, you are responsible for 100% of the payments to your provider.

This means that if you experience a lot of expensive dental problems in a given year, you could be paying for a substantial portion of that care. You can pay for this care with cash, check, or credit card. Some dental practices offer financing plans.

There are several options in terms of dental insurance. While it’s not mandated under ObamaCare, it can be offered to you through the Marketplace, and it must be offered to your children. You should take some time working out the details of your monthly budget to determine what amount of premium you can afford. You have to weigh the advantages of paying a premium so that you can get assistance with more expensive procedures versus paying for preventive care and any other treatments out-of-pocket. Enter your zip code in our FREE tool below to start comparing health insurance plans now!

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