Washington uses a state-run health insurance marketplace named Washington Health Plan Finder for the sale of certified individual/family dental plans.
Not all insurers who offer medical plans through the Washington 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 $45 to $99 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Washington in 2022 was $58.40.
If a family is purchasing coverage through the Washington Health Plan Finder, 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 pediatric stand-alone dental plans available in Washington 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 Washington’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, four insurers offer stand-alone individual/family dental coverage through Washington Health Plan Finder. These are dental plans that are not included with a medical plan and must be purchased separately:
These plans can be purchased through Washington Health Plan Finder 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 Washington. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Washington Division 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. 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.
For adults enrolled in Medicaid in Washington, there is no dental coverage provided for any level of care. For fully eligible children (up to age 21), Medicaid in Washington does provide routine preventive and restorative services.
For children in Washington, there is ALL Kids (which is Washington’s CHIP), a program which provides coverage to children and pregnant women with income above the eligibility limits for Medicaid. ALL Kids enrollees are able to receive up to $1,500 in covered dental benefits per year.
