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Iowa 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 Iowa exchange include pediatric 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 $33 to $118 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Iowa in 2022 was $42.43.
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 Iowa 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 Iowa benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, four insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in Iowa. 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 Iowa. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Iowa Insurance Division. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
There are also various dental discount plans available in every state. 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.
Adults eligible for Medicaid in Iowa can enroll in the Dental Wellness Plan, and receive access to extensive dental services. Kids aged 18 and under are eligible to enroll in Dental Wellness Plan Kids.
Hawki, which is Iowa’s CHIP, provides coverage to eligible children and pregnant women with income above the eligibility limits for Medicaid.
Iowa exchange enrollment hit a new record high in 2023, with more than 82,000 people signing up for coverage during open enrollment. Three insurers offer health plans in Iowa's exchange: Medica, Wellmark, and Oscar.
Iowa's Medicaid program provides a strong safety net for poor and low-income residents. Iowa’s Medicaid program covers beneficiaries at higher incomes than many other states do, and Iowa expanded Medicaid to low-income adults through the Affordable Care Act. As of April 2016, the state transitioned to a managed care system, but abandoned its Medicaid expansion demonstration waiver and shifted to straight expansion.
For all information on Medicare in Iowa, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
