Online Dental Insurance – Rights and Cost Sharing Under The ACA
Here is a quick summary of what you need to know about dental, your rights, and how cost sharing works on dental plans:
- A child must be offered dental, but you don’t have to take it.
- If you have dental coverage through the Marketplace it will typically have a maximum of $700 for a child or $1,400 for a family.
- Adults don’t have to be offered dental. However, many Marketplace plans offer dental as part of the plan, or as a standalone. You can’t cancel dental that is part of your plan, so keep this in mind.
- If dental is part of your plan, you can still use cost assistance to lower your plan costs.
- Even with cost assistance, when you reach the maximum,you typically pay 100% of the costs for dental work. This is the opposite of health insurance under the ACA where you pay 0% after your maximum. So don’t be confused by that.
- Oral surgery may be covered by medical insurance in some specific cases, but generally it doesn’t cover non-medically necessary procedures.
- Dental works best for routine care, it is uncommon to find any insurance that covers major dental work past a certain dollar amount. (“The Dental Gap”?)
