Maryland uses a fully state-run exchange known as the Maryland Health Connection for the sale of certified individual/family dental plans.
Not all insurers that offer medical plans through the Maryland exchange include dental services with their health plans. Both pediatric and adult dental coverage may be purchased through the exchange.
For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $21 to $90 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Maryland in 2022 was $46.71.
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 stand-alone dental plans available in Maryland 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 Maryland’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, there are four insurers who offer stand-alone individual/family dental coverage through the health insurance marketplace in Maryland. These are dental plans that are not included with a medical plan and must be purchased separately:
These plans can be purchased through the Maryland exchange 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 Maryland off the exchange. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Maryland Insurance Administration. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
In Maryland, there are also various dental discount plans available. Dental discount plans are not dental insurance, but can offer lower prices for services 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.
Starting in 2023 (due to legislation enacted in 2022), Maryland permanently expanded dental services for adult Medicaid recipients. Adults now have access to diagnostic, preventive, periodontal, and restorative services with no cap or annual benefit maximum. Children can receive dental services through Medicaid and the state’s Healthy Smiles program.
MCHP, which is Maryland’s CHIP, provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
