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. What Is the Affordable Care Act?
  2. How Can I Sign Up?
  3. How Can I Sign My Child Up?
  4. Considerations
  5. When Can I Get Started?
  6. Does ACA Insurance Help?
  7. References

The Affordable Care Act (ACA) mandates online marketplaces. These websites contain health insurance plans, dental insurance plans, and bundled plans covering both your physical and dental health.

Keep reading to find out how you can find a dental plan and make a smart choice for you and your family.

What Is the Affordable Care Act?

The Affordable Care Act (ACA), sometimes colloquially called Obamacare, was passed in 2010. It's been modified, altered, and debated since then, but it remains an important part of today's insurance landscape.

These four parts of the ACA should be familiar to you.

1. Mandates

Original ACA legislation required all consumers to have health insurance or pay a penalty.

In 2019, the individual mandate was repealed at the federal level. You won't see questions about your insurance coverage on federal taxes, and you won't pay fees if you don't have insurance.

However, some states maintained their mandates. If you live in California, for example, you are required to keep your health insurance coverage up-to-date.

Mandates don't apply to dental health insurance, so you aren't required to purchase a plan with dental assistance.

2. Essential Benefits

Legislators created a list of tests, procedures, and billing codes considered critical to health. No plan could exclude things deemed essential.

Are dental benefits essential?

  • For children: In ACA plans, dental coverage for children is an essential health benefit. Any plan you buy for a child must be bundled with dental insurance, or you should be able to buy an add-on product to help.
  • For adults: Dental coverage is not an essential health benefit. Plans don't have to give you options at all.

3. Marketplaces

As part of ACA protections, anyone could get health insurance. Before the ACA, most people had health insurance through their employers. If they worked alone or didn't have full-time jobs, they struggled to find health insurance.

Marketplaces allow people to find health insurance. Some states (like California) have marketplaces for their residents. Others (like Oregon) use the federal version. Online tools make finding your marketplace easy.

4. Subsidies

Tax credits included with the ACA make insurance more affordable for people with low incomes. The ACA also increased access to needs-based programs like Medicaid. Because of the ACA, more people got dental care, and cost barriers were reduced.

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.

How Can I Sign Up for Adult Dental Insurance?

Does your state have a marketplace, or should you use the national version? Use this tool to find out. Then, log in.

All marketplace plans fall into three basic categories:

  1. High (Gold): Pay a higher monthly premium for your insurance, and face lower copayments and deductibles.
  2. Low (Bronze): Pay a lower monthly premium, and prepare for higher out-of-pocket expenses, including deductibles.
  3. Moderate (Silver): Find a happy medium between deluxe and bare-bones plans.

Think about your healthcare needs, consider your dental needs, and then you're ready to shop. Choose one of these options.

Bundle

Some insurance companies combine health and dental insurance into one plan. You'll work with the same company and pay just one fee each month for full coverage.

This could be a good approach if your medical and dental needs are similar. But if you need extensive dental care and opt for a bronze insurance plan, you could pay too much at the dentist.

Shop

Find a separate dental insurance plan through the marketplace. Pay a separate premium payment each month, but know the premium will be adjusted based on your income, just like your standard health insurance.

If you sense a disconnect between your dental and medical needs, or you want to work with different companies on insurance, this is a smart choice.

How Can I Sign My Child Up for Insurance?

Like adult dental insurance, children’s dental insurance can either be combined with their healthcare plan or purchased separately.

The marketplace will alert you if you're considering a plan for a child, and you'll be reminded repeatedly to ensure that the plan covers dental care.

Once again, you can choose a bundled or separate plan. And you can opt for gold, silver, or bronze coverage levels.

Considerations Before You Choose a Dental Insurance Plan

The ACA marketplace will allow you to compare plan levels, costs, and listed benefits, so you can decide which type of plan suits you the best.

Before you make your final selection, consider these questions:

  • 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?
  • 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?

When Can I Get Started?

If you lose your job or move through what ACA officials consider a "qualifying event," you can sign up for an ACA plan immediately.

Otherwise, you must wait for the yearly open enrollment period. Typically, that begins in the fall. But your state may have shorter or longer deadlines.

Does ACA Dental Insurance Help?

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 standalone 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.

References

What Is the Affordable Care Act? U.S. Department of Health and Human Services. 

What the ACA Individual Mandate Repeal Means for You. (April 2021). Health Markets. 

Dental Coverage in the Marketplace. HealthCare.gov.

The Impact of the Affordable Care Act on Dental Care: An Integrative Literature Review. (August 2021). International Journal of Environmental Research and Public Health.

Affordable Care Act Marketplace. American Dental Association (ADA). 

Qualifying Life Event. Healthcare.gov. 

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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