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Georgia uses the federally facilitated health insurance marketplace HealthCare.gov for the sale of certified individual/family dental plans.
Not all insurers that offer medical plans through the Georgia 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 $22 to $102 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Georgia in 2022 was $45.11.
If a family in Georgia is purchasing coverage through HealthCare.gov, the premiums associated with children’s dental coverage may not be covered by premium tax credits (premium subsidies). Here’s more about how that works, and how it depends on whether the health plan has integrated pediatric dental benefits.
The stand-alone pediatric dental plans available on the Georgia exchange 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’s no cap on medically-necessary children’s dental benefits.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care are guided by Georgia’s essential health benefits benchmark plan.
Click here to see details for Georgia’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, seven insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in Georgia. 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 who sell stand-alone dental plans directly to consumers in the Peach State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Georgia Office of Insurance and Safety Fire Commissioner. If you would like to purchase a non-ACA qualified dental plan, speak to a dentist for recommendations or search online.
In Georgia, there are also various dental discount plans available. Dental discount plans are not insurance, but can offer discounted charges at participating dentists. Here’s what you need to know about the differences between dental insurance and dental discount plans.
To find plans where you live, do an online search for dental discount plans in the state of Georgia.
Adults enrolled in Medicaid in Georgia are only eligible to receive dental services if it’s a life-threatening situation or conducted in an emergency room, and then only on a case-by-case basis. Children under the age of 21 are eligible for comprehensive dental services through Georgia Medicaid.
PeachCare for Kids (PCK), which is Georgia’s CHIP, provides coverage to children and pregnant women with income above the eligibility limits for Medicaid.
Georgia's new reinsurance program took effect in 2022, helping to drive down average premiums. Enrollment reached a new record high in 2023, with more than 879,000 people signing up for coverage through Georgia's exchange during open enrollment. Georgia still uses HealthCare.gov, but the state also debuted its "Georgia Access" website in late 2022, directing visitors to a variety of insurers and web brokers. And Georgia is working to transition to a fully state-run exchange by the fall of 2023.
Georgia will partially expand Medicaid in mid-2023, but will not receive enhanced federal Medicaid expansion funding. The state's new program will extend coverage only to people who earn up to the poverty level and also work at least 80 hours per month, and it includes premiums for people with income above 50% of the poverty level. The Biden administration initially revoked approval for this, but Georgia sued and won in court, paving the way for the program to move forward.
For all information on Medicare in Georgia, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
