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Pennsylvania dental insurance guide 2022

Pennsylvania dental insurance guide 2022

Pennie has certified individual and family dental plans from seven insurers

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.

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 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
  • DentaQuest
  • Dominion National
  • EMI Health
  • Guardian

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.

Rite Care is Pennsylvania’s CHIP, and it provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

Dental resources in Pennsylvania

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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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.