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Are dental benefits included in ACA’s marketplace health plans?


Q. Are dental benefits included in the health insurance exchange plans?

A. Pediatric dental is one of the ACA’s essential health benefits. But there’s no requirement that dental care for adults be covered.

And even though pediatric dental is considered an essential health benefit, it works differently from the other nine essential health benefits. In some states, pediatric dental benefits are embedded in health insurance plans. But in most states, as long as there are stand-alone dental plans available for sale in the exchange, the health insurance plans in the exchange do not have to include pediatric dental coverage. Instead, applicants can be directed to purchase pediatric dental as a separate, stand-alone plan.

Because the Affordable Care Act didn’t address dental coverage for adults, the issue is an ongoing problem. Millions of Americans lack dental insurance, and end up delaying essential dental treatment because they can’t afford to pay for it.

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