A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994.
The District of Columbia uses a district-run health insurance marketplace named DC Health Link for the sale of certified individual/family dental plans.
Not all insurers who offer medical plans through the District of Columbia 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 stand-alone or family dental coverage through the exchange, premiums range from $11 to $51 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in DC in 2022 was $43.24.
If a family is purchasing coverage through DC Health Link, the premiums attached with pediatric dental coverage may or may not be canceled out by premium tax credits (premium subsidies). Here’s more about how that works, depending on whether the policy has integrated pediatric dental benefits.
The pediatric stand-alone dental plans available in the District of Columbia will comply with the ACA’s pediatric dental coverage rules. This means out-of-pocket costs for children’s 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 dental benefits for kids.
As with all essential health benefits, the specific coverage requirements for pediatric dental care are guided by DC’s essential health benefits benchmark plan.
Click here to see details for the District of Columbia’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, there are four insurers who offer stand-alone individual/family dental coverage through the health insurance marketplace in the District of Columbia. These are dental plans that are not included with a medical plan and must be purchased separately:
These plans can be purchased through DC Health Link during open enrollment (November 1 to January 31) 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 the nation’s capital. These plans are not subject to the ACA’s essential health benefit rules for children’s dental coverage, but they are regulated by the DC Department of Insurance, Securities, and Banking. To purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
In DC, there are also various dental discount plans available. Dental discount plans are not dental insurance, but can offer discounted rates at participating dentists. Here’s what you need to know to weigh the differences between dental insurance and dental discount plans.
To find dental discount plans in DC, search online for dental discount plans and the District of Columbia.
Adults and children enrolled in DC Medicaid are eligible for comprehensive dental benefits. Adult services are completed through a fee-for-service program.
DC Healthy Families, which is the District of Columbia’s CHIP, provides dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
The District of Columbia has by far the lowest percentage of subsidy-eligible exchange enrollees in the country, for a variety of reasons (although subsidies are now more widely available, due to the American Rescue Plan and Inflation Reduction Act). The District has an individual mandate, does not allow individual or small group plans to be purchased "off-exchange," and has sharply limited short-term health insurance plans. The District has also permanently extended open enrollment so it will run through January 31 each year. The District's COVID special enrollment period for uninsured residents continues through the end of the COVID public health emergency in the District.
Check short-term health insurance plan availability in DC and shop for coverage. Learn about state regulations regarding short-term plan duration and renewal.
The District of Columbia has more generous Medicaid eligibility requirements than most other parts of the country. More than one in three DC residents is covered by Medicaid.
For all information on Medicare in the District of Columbia, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
