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New York operates a state-run exchange called NY State of Health for enrollment in certified individual/family dental plans.
Not all insurers that offer medical plans through the New York 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 $23 to $108 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in New York in 2022 was $54.15.
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 stand-alone pediatric dental plans available through NY State of Health 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 York benchmark plan includes coverage for both basic and major dental services for children.
In 2023, seven insurers offer stand-alone individual/family dental coverage through NY State of Health. 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 16 to January 31) 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 York. 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 York. 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 York are eligible for dental services through the Healthy New York Plan. Children are also eligible for dental benefits through New York Medicaid.
Essential Plan is New York state’s Basic Health Plan which offers coverage outside the exchange for low income adults. The Essential Plan does provide preventive, routine, and major dental care for adult enrollees.
Child Health Plus, which is New York’s CHIP, provides dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
New York has fully embraced the Affordable Care Act, with a state-run exchange, expanded Medicaid, and the Essential Plan. New York State of Health has a dozen carriers offering individual market plans. The open enrollment period in New York runs from November 16 to January 31 (both dates differ from the schedule used in most other states). New York plans to expand the Essential Plan (Basic Health Program) so that it covers people with income up to 250% of the poverty level.
New York already had generous eligibility guidelines for Medicaid prior to the ACA's expansion, but the state is now benefitting from increased federal funding for the Medicaid expansion population. As of early 2023, there were more than 7.7 million New Yorkers enrolled in Medicaid, plus nearly 390,000 in Child Health Plus and 1.1 million in the Essential Plan. All of these enrollees will have their eligibility redetermined in 2023 and 2024, during the "unwinding" of the COVID-era continuous coverage rule.
For all information on Medicare in New York, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
