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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.
For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $26 to $82 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Virginia in 2022 was $56.19.
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 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 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 Virginia’s 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, 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 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 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.
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.
Twelve insurers are offering exchange coverage in Virginia for 2023, including Aetna's HMO affiliate (Aetna Health). Overall average premiums are decreasing for the fourth year in a row; the substantial decrease for 2023 is due in large part to the state's new reinsurance program. Virginia expects to have a fully state-run health insurance exchange by the fall of 2023.
Virginia expanded Medicaid in January 2019, and 450,000 people had enrolled by August 2020. That's more than the state had anticipated, due in large part to the widespread job losses caused by the COVID pandemic in 2020. The state had planned to impose a Medicaid work requirement, premiums, and cost-sharing, but has since withdrawn that proposal and is no longer pursuing it.
For all information on Medicare in Virginia, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
