Oregon 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 Oregon exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children.
For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $43 to $91 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Oregon in 2022 was $56.01.
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 in Oregon 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 Oregon benchmark plan does include 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 Oregon. These are dental plans that are not included with a medical plan and must be purchased separately:
This coverage can be purchased through Pennie 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 the Beaver State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Oregon 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 and individuals under the age of 21 enrolled in Medicaid in Oregon, known as the Oregon Health Plan (OHP), are eligible for extensive dental services. Those under 21 are eligible for additional services such as crowns, sealants, and root canals on the back teeth.
In conjunction with the OHP, Oregon operates its CHIP. This provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid. Services for CHIP clients are often administered through the state’s managed care delivery system.
