New Jersey uses a state-run exchange at GetCoveredNJ for the sale of certified individual/family dental plans.
Not all insurers that offer medical plans through the New Jersey exchange include pediatric or adult dental coverage with their health plans, but stand-alone plans are available for purchase.
For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $10 to $85 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in New Jersey in 2022 was $64.27.
If a family is purchasing coverage through GetCoveredNJ, 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 through the New Jersey marketplace 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.
The New Jersey benchmark plan includes coverage for both basic and major dental services for children.
In 2023, six insurers offers stand-alone individual/family dental coverage through the health insurance marketplace in New Jersey. 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 New Jersey. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the State of New Jersey Division 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. 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 enrolled in Medicaid in New Jersey are eligible for extensive dental services through NJ FamilyCare. Children are also eligible for dental benefits through New Jersey Medicaid.
NJ FamilyCare, which also includes New Jersey’s CHIP, provides free or low-cost dental coverage to qualifying residents of any age, including uninsured children and pregnant women with income above the eligibility limits for Medicaid.
