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Wisconsin dental insurance guide 2022

Wisconsin dental insurance guide 2022

Wisconsin's health insurance marketplace has certified individual and family dental plans from seven insurers

Dental insurance in Wisconsin

Wisconsin 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 Wisconsin 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 Wisconsin?

For adults who purchase their own stand-alone or family dental coverage through the exchange, premiums range from $23 to $95 per month.

IHC Specialty Benefits reports that the average monthly premium for a stand-alone family dental plan sold in Wisconsin over a two-year period (2020-2021) was $46.24. (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 Wisconsin

The pediatric stand-alone dental plans available in Wisconsin 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 Wisconsin’s benchmark plan, which does include coverage for both basic and major dental services for children.

Seven insurers offer stand-alone dental plans through the Wisconsin exchange

In 2022, there are seven insurers that offer stand-alone individual/family dental coverage through the health insurance marketplace in Wisconsin. These are dental plans that are not included with a medical plan and must be purchased separately:

  • Anthem BCBS
  • Delta Dental of Wisconsin
  • DentaTrust/DentaSpan
  • Guardian
  • Humana
  • Renaissance Dental
  • Together with CCHP

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 Wisconsin’s exchange?

There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in Wisconsin. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Wisconsin 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 locate these plans in your area, search online for dental discount plans and the state of Wisconsin.

Medicaid/CHIP dental coverage in Wisconsin

Adults and children enrolled in Medicaid in Wisconsin are eligible for extensive dental services through BadgerCare+. The benefits do not cover orthodontia and some other procedures require prior approval.

BadgerCare+ also administers Wisconsin’s CHIP, and provides comprehensive dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

Dental resources in Wisconsin

Related articles

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.
Pediatric dental is one of the essential health benefits, although it’s a bit more complicated than the other nine. Some medical policies have pediatric dental embedded in the plan, and ...

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Although Wisconsin has not expanded Medicaid under the guidelines laid out in the ACA, the state's Badger Care Medicaid program does cover all legally present residents with incomes under the poverty level. Wisconsin is the only non-Medicaid-expansion state that does not have a coverage gap; all legally-present low-income residents either have access to Medicaid or subsidies to help them purchase private coverage in the exchange. Wisconsin had planned to implement premiums and a modified work requirement in 2020, but delayed those changes due to COVID-19. And the work requirement approval was revoked by the Biden administration in 2021.

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Medicare in Wisconsin

For all information on Medicare in Wisconsin, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.

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Learn about health insurance coverage options in your state.

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.