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Massachusetts dental insurance guide 2022

Massachusetts dental insurance guide 2022

Massachusetts Health Connector has certified individual and family dental plans from two insurers

Dental insurance in Massachusetts

Massachusetts uses a state-based health insurance exchange called Massachusetts Health Connector for the sale of certified individual/family dental plans as well as small group dental options.

All insurers that offer medical plans through the Massachusetts exchange include pediatric dental coverage with their health plans, and a few offer limited adult coverage. Stand-alone dental plans are available for both children and adults through the Connector all year.

How much does dental insurance cost in Massachusetts?

For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums average $65 per month.

IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Massachusetts over a two-year period (2020-2021) was $65.23. (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 Massachusetts

All insurers that offer medical plans through the Massachusetts exchange include pediatric dental coverage with their health plans. To purchase a stand-alone dental plan for someone under 19 years old without medical coverage, you must contact the exchange directly at 1-877-MA-ENROLL. Otherwise, family and adult plans are available through the website.

The exchange-certified pediatric stand-alone dental plans available in Massachusetts 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 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 Massachusetts’s benchmark plan, which does include coverage for both basic and major dental services for children.

Two insurers offer stand-alone dental plans through the Massachusetts exchange

Adult and family dental coverage is not automatically included with the medical plans from insurers who offer coverage through Massachusetts’s health insurance marketplace.

In 2022, two insurers offer stand-alone individual/family dental coverage through Massachusetts Health Connector. These are dental plans that are not included with a medical plan and must be purchased separately:

  • Altus Dental
  • Delta Dental

These dental plans can be purchased through the Massachusetts exchange at any time during the year, and not just 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. Massachusetts also offers non-standardized plans through the exchange that offer different features and out-of-pocket costs.

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

There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in the Bay State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Massachusetts Division of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.

In Massachusetts, there are also various dental discount plans available. Dental discount plans are not insurance, but they can offer discounted charges 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 Massachusetts

Adults enrolled in Medicaid in Massachusetts are eligible for dental services. Children enrolled in MassHealth are eligible for various dental programs (based on their families’ benefit level) to ensure continuous coverage until the age of 21.

KanCare, which is Massachusetts’s CHIP, provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

Dental resources in Massachusetts

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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.
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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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