Delaware uses the federally facilitated health insurance marketplace at HealthCare.gov for the sale of certified individual/family dental plans.
Not all insurers who offer medical plans through the Delaware 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 Delaware exchange, premiums range from $37 to $80 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Delaware in 2022 was $47.06.
If your family is purchasing coverage through the Delaware exchange, the premiums connected with pediatric dental coverage may not be offset by premium tax credits (premium subsidies). Here’s more about how that works, and how it relates to whether the health policy includes integrated pediatric dental benefits.
All stand-alone pediatric dental plans in Delaware comply with the ACA’s pediatric dental coverage rules. This means out-of-pocket costs for pediatric dental care will not go over $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 Delaware’s essential health benefits benchmark plan.
You can see details here for Delaware’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, two insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in Delaware. These are dental plans that are not included with a medical plan and must be purchased separately:
These plans can be purchased through Choose Health Delaware 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.
In Delaware, there’s also a variety of dental insurers who sell stand-alone dental plans directly to consumers. These policies are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Delaware Department of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask your dentist for recommendations or search for policies online.
There are also various dental discount plans available in Delaware. Dental discount plans are not insurance, but can offer discounted prices at participating dentists. Here’s what you need to know about the differences between dental insurance and dental discount plans.
To find these plans where you live, search online for dental discount plans and Delaware.
Adults enrolled in Delaware Medicaid are eligible to receive basic dental services up to $1,000 a calendar year, with $1,500 available (prior authorization required) for emergency care as an extended benefit. Children (up to age 20) enrolled in Delaware Medicaid are eligible for comprehensive dental services such as preventive, restorative care and braces.
Delaware Healthy Children Program (DHCP) , Delaware’s CHIP, provides comprehensive dental coverage to the state’s uninsured children under the age of 19.
