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Virginia dental insurance guide
The state’s health insurance Marketplace has certified individual and family dental plans from seven insurers
Virginia 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 Virginia exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children.
Frequently asked questions about dental coverage in Virginia
How much does dental insurance cost in Virginia?
For adults who purchase their own stand-alone dental coverage through the exchange in Virginia, premiums in May 2024 ranged from about $8 to $33 per month.1
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.
Are stand-alone pediatric dental plans on the exchange ACA-compliant?
All stand-alone pediatric dental plans available on the Virginia Health Insurance Marketplace will comply with the ACA’s pediatric dental coverage rules.
This means the out-of-pocket costs for pediatric dental care on a stand-alone dental plan purchased via the Virginia Health Insurance Marketplace won’t exceed $400 per child in 2024 (or $800 for all the children on a family’s plan),2 and there is no cap on medically necessary pediatric dental benefits. (For 2025, the out-of-pocket maximums will increase to $425 and $850, respectively.3)
If a medical plan has embedded pediatric dental benefits, the maximum out-of-pocket limits described above are not applicable. However, there will be no limit on how much the plan will pay for pediatric dental care, since it’s an essential health benefit.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care (either embedded in an ACA-compliant individual market plan, or obtained via the Virginia Health Insurance Marketplace as a stand-alone dental plan) are guided by the state’s essential health benefits benchmark plan.
You can see details here for Virginia’s benchmark plan, which does include coverage for both basic and major dental services for children.
Which insurers offer dental coverage through the Virginia marketplace?
In 2024, seven insurers offer stand-alone individual/family dental coverage through the health insurance marketplace, with coverage available for both adult and pediatric dental services. These are dental plans that are not included with a medical plan and must be purchased separately.
These plans can be purchased through the Virginia Health Insurance Marketplace 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 Virginia's exchange?
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in the Old Dominion State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Virginia State Corporation Commission (SCC). If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
In Virginia, there are also various dental discount plans available for purchase. 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.
How does Virginia Medicaid and CHIP provide dental coverage?
Both children and adults enrolled in Medicaid in Virginia have comprehensive dental coverage.4 The benefits were expanded for adults starting in 2021.5
FAMIS, Virginia’s CHIP, provides dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
What dental resources are available in Virginia?
- Virginia Dental Association
- Virginia free or low-cost dental clinics
- Virginia Medicaid
- Virginia Health Insurance Marketplace (new as of 2024; Virginia previously used the HealthCare.gov Marketplace platform)
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
Footnotes
- ”Enroll Home – Virginia’s Insurance Marketplace” marketplace.virginia.gov. Accessed May 29, 2024 ⤶
- ”2024 Final Letter to Issuers in the Federally-facilitated Exchanges” Centers for Medicare & Medicaid Services. May 1, 2023 ⤶
- ” 2025 Final Letter to Issuers in the Federally-facilitated Exchanges” CMS.gov. April 10, 2024 ⤶
- ”Dental Overview” Virginia Medicaid. Accessed July 10, 2024 ⤶
- ”Smiles For Children Adult Dental Benefit; Frequently Asked Questions” DentaQuest and Virginia Department of Medical Assistance Services (DMAS). Accessed July 10, 2024 ⤶