Vermont uses a state-run health insurance marketplace at Vermont Health Connect for the sale of certified individual/family dental plans.
Not all insurers who offer medical plans through the Vermont 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 $47 to $203 per month based on the plan tier and who is enrolled.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Vermont in 2022 was $52.84.
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.
All stand-alone pediatric dental plans available through Vermont Health Connect will comply with the ACA’s pediatric dental coverage rules. This means out-of-pocket costs for pediatric dental services 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 see details here for Vermont’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, one insurer offers stand-alone individual/family dental coverage through the health insurance marketplace, in Vermont. These are dental plans that are not included with a medical plan and must be purchased separately:
These plans can be purchased through Vermont Health Connect 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 Vermont. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by Vermont’s Insurance Division. 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. Here’s what you need to know 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 Vermont are eligible for substantial dental services. Adults have an annual cap of $1,000 per calendar year, with preventive services not counting towards that maximum. Medicaid dental benefits in Vermont do not cover cosmetic procedures and only certain elective procedures, which will likely require prior authorization. Children enrolled for Medicaid are eligible to receive the same benefits as adults with no annual cap.
Dr. Dynasaur, Vermont’s CHIP, provides extensive dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
