Florida uses the federally facilitated health insurance marketplace HealthCare.gov for the sale of certified individual/family dental plans.
Not all insurers who offer medical plans through the Florida 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 $18 to $98 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Florida in 2022 was $31.14.
For families purchasing coverage through Florida’s health insurance exchange, the premiums attached to pediatric dental coverage may not be paid for 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 policies available in Florida 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), with no cap on medically-necessary pediatric dental benefits.
As with all essential health benefits, the specific coverage requirements for pediatric dental care are guided by Florida’s essential health benefits benchmark plan.
You can see details here for Florida’s benchmark plan, which includes coverage for both basic and major dental services for children.
In 2023, there are 11 insurers who offer stand-alone individual/family dental plans through the Florida health insurance marketplace. 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 the Sunshine State. These policies are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Florida Office of Insurance Regulation. If you would like to purchase an off-exchange dental plan, ask a dentist for recommendations or search online.
In Florida, there are also various dental discount plans available. 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 county, search online for dental discount plans and the state of Florida.
Children enrolled in Medicaid in Florida receive comprehensive dental coverage at no cost. For adults enrolled in Medicaid, coverage is limited to emergency-based dental services, but has been expanded to include basic dental care (cleanings and fillings for example) for qualified individuals over 21.
Florida KidCare (Florida’s CHIP) provides coverage to children and pregnant women with income above the eligibility limits for Medicaid.
