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North Carolina dental insurance guide 2022

North Carolina dental insurance guide 2022

North Carolina's health insurance marketplace has certified individual and family dental plans from four insurers

Dental insurance in North Carolina

North Carolina uses the federally facilitated health insurance marketplace HealthCare.gov for the sale of certified individual/family dental plans.

Not all insurers that offer medical plans through the North Carolina exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children.

How much does dental insurance cost in North Carolina?

For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $42 to $102 per month.

IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in North Carolina over a two-year period (2020-2021) was $53.27. (Typical family size was 1.2 to 1.4 persons.)

If a family is purchasing coverage through the North Carolina marketplace, 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 North Carolina

The stand-alone pediatric dental plans available in North Carolina 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.

The North Carolina benchmark plan includes coverage for both basic and major dental services for children.

Four insurers offer stand-alone dental plans through the North Carolina exchange

In 2022, four insurers offers stand-alone individual/family dental coverage through the health insurance marketplace in North Carolina. These are dental plans that are not included with a medical plan and must be purchased separately:

  • BEST Life
  • Delta Dental of Minnesota

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.

Can I buy dental insurance outside of North Carolina’s exchange?

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

Medicaid/CHIP dental coverage in North Carolina

Adults enrolled in Medicaid in North Carolina are eligible for extensive dental services with no annual spending limits. Children are eligible to receive extensive dental benefits either through Medicaid or Health Choice, the state’s Medicaid managed care program.

North Carolina Health Choice for Children (NCHC), which is North Carolina’s CHIP, provides dental coverage to uninsured children ages six through 18 who are not enrolled in Medicaid.

Dental resources in North Carolina

Related articles

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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