Hawaii uses the federally-run health insurance marketplace at HealthCare.gov for the sale of certified individual/family dental plans.
Not all insurers who offer medical plans through the Hawaii 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 $47 to $97 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Hawaii in 2022 was $40.43.
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 Hawaii 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 the Hawaii benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, three insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in Hawaii. These are dental plans that are not included with a medical plan and must be purchased separately:
This coverage 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 Hawaii. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Hawaii Department of Commerce and Consumer Affairs. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
In Hawaii, there are also various dental discount plans available. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Learn 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.
Thanks to legislation passed in 2022, adults with Medicaid in Hawaii can now receive prevention based benefits to extensive dental treatment through Medicaid. Children with Medicaid in Hawaii are eligible for routine dental care, but not orthodontics.
In Hawaii, the Med-QUEST Division has a dental program that provides dental services to adults and children who are eligible for Medicaid. Adults with Medicaid in Hawaii can receive emergency benefits to control pain and infection.
Hawaii’s Children’s Health Insurance Program (CHIP) provides comprehensive dental coverage to the state’s uninsured children under the age of 19 who would not qualify for Medicaid. Routine care is free, but other services may have a co-payment.
