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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.
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 in 2022 was $42.28.
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.
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 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 Wisconsin’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2023, 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:
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 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.
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.
Wisconsin's exchange remains among the most robust in the country, with 14 insurers offering plans for 2022. The state implemented a reinsurance program in 2019 that resulted in average premium reductions in 2019, 2020, 2021, and again for 2022.
Wisconsin short-term plans cannot have total durations of more than 18 months, including renewals.
Wisconsin has not expanded Medicaid under the guidelines laid out in the ACA, however the state's Badger Care Medicaid program does cover all legally present residents with incomes under the poverty level.
For all information on Medicare in Wisconsin, healthinsurance.org has you covered. Get all the resources you need to make an informed decision.
