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Maine dental insurance guide 2022

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Maine dental insurance guide 2022

Maines's health insurance marketplace has certified individual and family dental plans from one insurer

Dental insurance in Maine

Maine uses a fully state-run exchange known as CoverME.gov for the sale of certified individual/family dental plans.

Not all insurers that offer medical plans through the Maine exchange include dental coverage with their health plans, but pediatric and adult dental coverage can be purchased as a stand-alone plan through CoverME.gov.

How much does dental insurance cost in Maine?

For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums average $40 per month.

IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Alabama over a two-year period (2020-2021) was $40.46.10. (Typical family size was 1.2 to 1.4 persons.)

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.

Pediatric dental benefits in Maine

In Maine, the exchange-certified pediatric stand-alone dental plans available will comply with the ACA’s rules for children’s dental coverage.. This means out-of-pocket costs for kids dental care will not exceed $375 per child in 2022 (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 Maine’s benchmark plan, which does include coverage for both basic and major dental services for children.

One insurer offers stand-alone dental plans through the Maine exchange

In 2022, there is only one insurer who offers stand-alone individual/family dental coverage through the health insurance marketplace in Maine. These are dental plans that are not included with a medical plan and must be purchased separately:

  • Northeast Delta Dental

These plans can be purchased through CoverME.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.

 

Can I buy dental insurance outside of Maine’s exchange?

There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in Maine. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Maine Bureau of Insurance. 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. 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.

Medicaid/CHIP dental coverage in Maine

Adults enrolled in Medicaid in Maine, known as MaineCare, are eligible for limited emergency dental services. Children (under age 21) who are enrolled in MaineCare are eligible for more comprehensive dental benefits.

MaineCare also administers Maine’s CHIP, which provides comprehensive dental coverage to uninsured children up to age 19.

Dental resources in Maine

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Here's what you need to know when you're shopping for adult dental coverage through a state health insurance marketplace or directly from a dental plan carrier.
There is no penalty for not having pediatric dental on your policy – and in most exchanges, you can purchase a plan without pediatric dental. But off-exchange, carriers are required ...
If you're an adult who bought a dental insurance plan, your out-of-pocket costs will depend entirely on the amount of dental care you need during the year. But for children, ...
For those who purchase their own insurance, the decision to purchase dental coverage is not always as clear-cut as the decision to purchase health insurance.
Pediatric dental is one of the essential health benefits, although it’s a bit more complicated than the other nine. Some medical policies have pediatric dental embedded in the plan, and ...
Dental insurance and dental discount plans can both be useful in terms of reducing your total dental costs, but they vary significantly in terms of the benefits you get and ...

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