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Virginia dental insurance guide 2022

Virginia dental insurance guide 2022

The state's health insurance marketplace has certified individual and family dental plans from eight insurers

Dental insurance in Virginia

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.

How much does dental insurance cost in Virginia?

For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $30 to $81 per month.

IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Virginia over a two-year period (2020-2021) was $52.48. (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 Virginia

All stand-alone pediatric dental plans available on the Virginia exchange 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 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.

You can see details here for Virginia’s benchmark plan, which does include coverage for both basic and major dental services for children.

Eight insurers offer stand-alone dental plans through the Virginia exchange

In 2022, eight 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:

  • Anthem BCBS
  • DSM USA
  • Delta Dental of Virginia
  • Dental Care Plus
  • Dentegra
  • Dominion National
  • Guardian
  • Renaissance Dental

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.

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.

Medicaid/CHIP dental coverage in Virginia

Adults enrolled in Medicaid or FAMIS in Virginia are eligible for a comprehensive dental benefit, with a focus on preventive services and restoration. Children enrolled for Medicaid are eligible to receive the same benefits as adults, with the addition of root canals and crowns.

FAMIS, Virginia’s CHIP, provides dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

Dental resources in Virginia

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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.
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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.