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West 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 West 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 $29 to $54 per month.
IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in West Virginia in 2022 was $50.34.
If a family is purchasing coverage through the West Virginia 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.
The pediatric stand-alone dental policies available on the West Virginia marketplace will comply with the ACA’s pediatric dental coverage rules. For residents, this means out-of-pocket costs for children’s dental care will not exceed “https://www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/Final-2023-Letter-to-Issuers.pdf” $375 per child in 2023 (or $750 for all the children on a family’s plan), and there isn’t a cap on medically-necessary dental services.
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 West Virginia’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, there is only one insurer offering stand-alone individual/family dental coverage through the health insurance marketplace in West Virginia. 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 Mountain State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the West Virginia Offices of the Insurance Commissioner. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
In West Virginia, there are also various dental discount plans available. 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 in West Virginia are eligible for emergency dental services only, such as procedures to treat fractures, pain or infection. Children enrolled in Medicaid are eligible to receive more comprehensive dental services up to the age of 21.
WVCHIP, which is West Virginia’s CHIP, provides coverage for a broad range of dental services to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
West Virginia's exchange has two insurers offering plans for 2023. Premiums are much higher than the national average in WV. But the American Rescue Plan's additional subsidies made coverage more affordable, and subsidies became even larger in 2022 due to silver loading the cost of CSR. Enrollment grew to more than 28,000 for 2023 coverage — higher than the last several years, but well below 2016's record high enrollment.
West Virginia’s leaders opted to expand Medicaid under the ACA as of January 1, 2014, and enrollment has grown by 80% due to Medicaid expansion and the COVID pandemic. Disenrollments resume in April 2023 in West Virginia, after a three-year pandemic-related pause. West Virginia expanded its CHIP coverage in 2019 to include pregnant women, and has extended postpartum coverage to 12 months.
For all information on Medicare in West Virginia, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
