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Oregon dental insurance guide 2023

Oregon dental insurance guide 2023

Oregon's health insurance marketplace has certified individual and family dental plans from six insurers

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.

Frequently asked questions about dental coverage in Oregon

How much does dental insurance cost in Oregon?

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.

Are stand-alone pediatric dental plans on the exchange ACA-compliant?

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.

Which insurers offer dental coverage through the Oregon marketplace?

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:

  • Delta Dental of Oregon
  • Dental Health Services
  • Dentegra
  • Dominion National
  • Kaiser Permanente
  • PacificSource Health

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.

Can I buy dental insurance outside of Oregon's exchange?

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.

How does Oregon Medicaid and CHIP provide dental coverage?

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.

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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, ...
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Oregon health insurance marketplace guide 2023

Six insurers offer 2023 plans in Oregon's exchange; average rates increased by less than 7% before subsidies were applied. Oregon is working to establish a Basic Health Program, as well as temporary additional Medicaid expansion to create a "bridge to the bridge" program until the BHP is up and running.

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Oregon health insurance marketplace guide 2023

Short-term health insurance in Oregon

Check short-term health insurance plan availability in Oregon and shop for coverage. Learn about state regulations regarding short-term plan duration and renewal.

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Medicaid eligibility and enrollment in Oregon

Oregon has a long history of going beyond federal minimums in terms of Medicaid eligibility criteria. The state expanded Medicaid under the ACA, and provides income-based Medicaid to children regardless of immigration status. Oregon also provides continuous eligibility for children until age 6, and 24 months of continuous eligibility for people age 6 and older.

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Medicare in Oregon

For all information on Medicare in Oregon, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.

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Learn about health insurance coverage options in your state.

Our state guides offer up-to-date information about ACA-compliant individual and family plans and marketplace enrollment; Medicaid expansion status and Medicaid eligibility; short-term health insurance regulations and short-term plan availability; and Medicare plan options.