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Kentucky uses a fully state-run exchange known as Kynect for the sale of certified individual/family dental plans.
Not all insurers that offer medical plans through the Kentucky exchange include pediatric dental coverage with their health plans.
For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $24 to $110 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Kentucky in 2022 was $45.37.
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 exchange-certified pediatric dental plans available in Kentucky 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
Pediatric dental coverage is not automatically included with the medical plans from insurers who offer coverage through Kentucky’s health insurance marketplace.
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 Kentucky’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, there are two insurers who offer stand-alone individual/family dental coverage through the health insurance marketplace in Kentucky. Some health plans include both adult and pediatric coverage, some cover only one group, and other plans offer coverage to neither.
These are dental plans that are not included with a medical plan and must be purchased separately:
These plans can be purchased through Kynect 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 Kentucky. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Kentucky Department of Insurance.
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. Here’s what you need to know 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 and children enrolled in Medicaid in Kentucky are eligible to receive limited dental services such as exams, x-rays, emergency visits, extractions and fillings.
KCHIP, which is Kentucky’s CHIP, provides dental coverage to children up to age 19 living with families who have income above the eligibility limits for Medicaid.
Kynect is once again the exchange platform in Kentucky. For 2023, overall average premiums increased by an average of about 6%. Four insurers offer plans, and nearly every county has at least two participating insurers for 2023. Kentucky had been planning to establish a Basic Health Program that was to be available for 2024, but is no longer working on that as of early 2023.
Kentucky's Medicaid work requirement, part of the state's Kentucky HEALTH waiver, was approved twice by CMS. But it faced legal challenges and was never implemented, and Governor Andy Beshear terminated the waiver in late 2019. Lawmakers are working to impose a new Medicaid work requirement that would take effect in 2023, but federal approval is unlikely.
For all information on Medicare in Kentucky, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
