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Tennessee uses the federally facilitated health insurance marketplace HealthCare.gov for the sale of certified individual/family dental plans.
Not all insurers who offer medical plans through the Tennessee 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 $18 to $82 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Tennessee in 2022 was $40.94.
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 Tennessee 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 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.
You can review details of the Tennessee benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, eight insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in Tennessee. These are dental plans that are not included with a medical plan and must be purchased separately:
These plans 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.
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in the Volunteer State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Tennessee Division of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
In Tennessee, there are also various dental discount plans available. Dental discount plans are not insurance, but they can get consumers lower 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.
Beginning in 2023, adults enrolled in Medicaid in Tennessee, known as TennCare, will be eligible for dental benefits. Extensive dental benefits for pregnant and postpartum beneficiaries began in April of 2022. Children enrolled in Medicaid are eligible to receive comprehensive dental benefits as long as they are deemed medically necessary.
CoverKids, which is Tennessee’s CHIP, provides dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
There continue to be six insurers offering health plans in Tennessee's exchange as of 2023, although Bright Health left at the end of 2023 and U.S. Health & Life joined for 2023. The overall average rate increase was 8.5% for 2023, but subsidies continue to be larger and more widely available due to the American Rescue Plan and Inflation Reduction Act.
Tennessee has not expanded Medicaid, but sought federal approval for a Medicaid work requirement (which was not approved by the Biden administration). The state received approval for a transition to a modified block grant funding model, but its future is also uncertain under the Biden administration, which has asked for significant changes to the proposal.
For all information on Medicare in Tennessee, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
