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Arizona uses the federally facilitated health insurance marketplace – HealthCare.gov – for the sale of certified individual/family dental plans, as well as small group dental plans.
Not all insurers who offer medical plans through the Arizona exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children.
For adults who purchase their own or family stand-alone dental coverage through the exchange, premiums range from $31 to $104 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Arizona in 2022 was $47.43.
If a family is purchasing coverage through the health insurance exchange, the premiums associated with pediatric dental coverage may or may not be offset by premium tax credits (premium subsidies). Here’s more about how that works, depending on whether the health plan has integrated pediatric dental benefits.
The stand-alone pediatric dental plans available in Arizona will comply with the ACA’s pediatric dental coverage rules. This means out-of-pocket costs for pediatric dental care will not exceed $375 per child in 2023 (or $750 for all the children on a family’s plan), and there is no cap on medically-necessary pediatric dental benefits.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care are guided by the state’s essential health benefits benchmark plan.
You can see details here for Arizona’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, there are nine insurers that offer stand-alone individual/family dental coverage through the health insurance marketplace in Arizona. These are dental plans that are not included with a medical plan and must be purchased separately:
These plans can be purchased through HealthCare.gov during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event. Exchange-certified stand-alone dental plans are compliant with the ACA’s rules for pediatric dental coverage.
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in Arizona. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Arizona Department of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
There are also various dental discount plans available in every state. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Here’s what you need to know about the differences between dental insurance and dental discount plans.
To find plans in your area, search online for dental discount plans and the state you are looking to buy a plan in.
Adults enrolled in Medicaid in Arizona are eligible to receive up to $2,000 in total dental services, divided between diagnostic/preventive and emergency dental care. Eligible children (up to age 21) are also able to access emergency or medically necessary dental services.
KidsCare (which is Arizona’s CHIP) provides coverage to children and pregnant women with income above the eligibility limits for Medicaid.
Six carriers are offering plans in Arizona's exchange for 2021. For 2022, four of the six insurers are decreasing their rates, and two new insurers are joining the exchange: Banner/Aetna CVS Health will join the exchange in Maricopa, Pima, and Pinal counties, and Medica Community Health Plan is also joining the exchange. BCBSAZ is reintroducing a PPO product, after a six-year hiatus.
The Trump administration approved Arizona's work requirement proposal in early 2019, but rejected the state's proposal to cap eligibility at five years for people who don't comply with the work requirement. But Arizona decided to indefinitely postpone implementation of the work requirement, and the Biden administration officially withdrew the approval in mid-2021.
For all information on Medicare in Arizona, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
