- What are typical dental insurance costs in Pennsylvania?
- Stand-alone pediatric dental plans in Pennsylvania comply with the ACA’s pediatric dental coverage rules.
- In 2022, seven insurers offer stand-alone dental plans in Pennsylvania’s marketplace.
- Off-exchange stand-alone dental plans are available in Pennsylvania.
- See how Medicaid and CHIP cover dental in Pennsylvania.
- Review our list of Pennsylvania dental resources.
Dental insurance in Pennsylvania
Pennsylvania operates a state-run health insurance exchange called Pennie for the sale of certified individual/family dental plans.
Not all insurers that offer medical plans through the Pennsylvania 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 Pennsylvania?
For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $18 to $81 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Pennsylvania over a two-year period (2020-2021) was $58.38. (Typical family size was 1.2 to 1.4 persons.)
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.
Pediatric dental benefits in Pennsylvania
The stand-alone pediatric dental plans available in Pennsylvania 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.
The Pennsylvania benchmark plan does include coverage for both basic and major dental services for children.
Seven insurers offer stand-alone dental plans through the Pennsylvania exchange
In 2022, seven insurers offers stand-alone individual/family dental coverage through the health insurance marketplace in Pennsylvania. These are dental plans that are not included with a medical plan and must be purchased separately:
- BEST Life
- Capital Blue Cross
- Delta Dental
- Dominion National
- EMI 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 Pennsylvania’s exchange?
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in the Keystone State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Pennsylvania Insurance Department. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
In Pennsylvania, there are also various dental discount plans available. 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 Pennsylvania
Adults and children enrolled in Medicaid in Pennsylvania are eligible for extensive dental services. For adults (age 21 and over) that does not include orthodontia or general anesthesia, but does include all other non-cosmetic dental care.
For children (up to age 18) the state’s Medicaid dental services are run through a dental plan named Rite Smiles.
Dental resources in Pennsylvania
- Pennsylvania Dental Association
- Low-fee dental clinics in Pennsylvania
- Pennsylvania Medicaid (MA)
- Pennsylvania CHIP