A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994.
Texas 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 Texas 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 $109 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Texas in 2022 was $47.18.
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 Texas 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.
See details of the Texas benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, there are 12 insurers that offer stand-alone individual/family dental coverage through the health insurance exchange in Texas. 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 Lone Star State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Texas Department 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 children enrolled in Medicaid in Texas are part of STAR, a managed care plan that operates across the state. Adults are eligible for limited dental services. Children enrolled in Medicaid are eligible to receive more comprehensive dental services.
Texas Health Steps, which is Texas’s CHIP, provides dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
15 insurers offer 2023 coverage in Texas health insurance exchange. Premium subsidies are larger than ever due to new a Texas rate-setting rule.
Texas has not expanded Medicaid under the ACA. And they also have the most stringent eligibility guidelines in the country for non-disabled adults. As a result, Texas has the highest uninsured rate and the biggest coverage gap in the country, with at least 759,000 residents — and possibly as many as 1 million — ineligible for Medicaid and also ineligible for premium subsidies to offset the cost of private coverage in the exchange. Texas plans to prioritize people unlikely to still be Medicaid-eligible once the pandemic-era continuous coverage requirements end in April 2023.
For all information on Medicare in Texas, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
