Can I get dental insurance through the Marketplace?

Is dental insurance available through the Marketplace?

Pediatric dental is one of the ACA's essential health benefits. But there's no requirement that dental care for adults be covered.¹ 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, either because the state requires this or because the insurers choose to take this approach. But in most states, as long as there are stand-alone dental plans available for sale in the exchange (which is generally the case nationwide),² health insurance plans in the exchange do not have to include pediatric dental coverage. Instead, applicants can be directed to purchase pediatric dental coverage as a separate, stand-alone plan.

Are the health insurance exchanges required to offer dental coverage for adults?

No, there is no requirement that the exchanges offer adult dental coverage, as this is not considered an essential health benefit under the ACA. But according to an analysis of 2023 coverage, adult dental coverage is available in the exchanges nationwide, either embedded in health plans or as stand-alone coverage.³

Most Marketplace health plans – more than 91%, according to the analysis of 2023 coverage – do not include embedded adult dental coverage.³

Adults can choose to purchase stand-alone coverage in the Marketplace in addition to a health plan. But since this is not an essential health benefit, the plans often include fairly low annual benefit caps. (For pediatric dental coverage, insurers cannot impose a dollar limit on the benefits, since pediatric dental is considered an essential health benefit and those cannot have annual or lifetime caps on how much the insurer will pay for treatment.)⁴

Do I have to buy a health plan in order to buy a dental plan through the Marketplace?

In most states, you can only enroll in a Marketplace dental plan if you’re also enrolling in a Marketplace health plan. This is true in all of the states that use HealthCare.gov,¹ as well as California⁵ and Washington.⁶

However, most of the state-run Marketplaces will allow you to enroll in just a Marketplace dental plan during open enrollment or a special enrollment period, without also enrolling in a health plan. They include:

• Colorado⁷
• Connecticut⁸
• District of Columbia⁹
• Georgia¹⁰
• Idaho¹¹
• Illinois¹²
• Kentucky¹³
• Maine¹⁴
• Maryland¹⁵
• Massachusetts (available year-round)¹⁶
• Minnesota¹⁷
• Nevada¹⁸
• New Jersey¹⁹
• New Mexico (available year-round)²⁰
• New York²¹
• Pennsylvania²²
• Rhode Island²³
• Vermont²⁴
• Virginia²⁵

Are there metal levels for dental coverage available through the Marketplace?

No, Marketplace dental coverage is not categorized by metal levels the way health plans are.

Pediatric dental is an essential health benefit (EHB), so Marketplace pediatric dental coverage must comply with various rules. Adult dental is not an EHB in any state, so there are no specific coverage requirements for adult dental.²⁶ Adult dental benefits are not considered EHB in any state,²⁷ so even if adult dental benefits are embedded in a medical plan, they are not taken into consideration when determining the plan’s metal level.

Stand-alone pediatric dental benefits are sometimes categorized as “high” or “low” AV, although this is no longer a federal requirement. HHS eliminated this requirement starting in 2019, to give insurers more flexibility in how they design stand-alone pediatric dental plans. But stand-alone pediatric dental plans are required to cap maximum out-of-pocket costs. And a plan’s certified AV must be reported to the Marketplace.²⁸

Do Marketplace dental plans cover pre-existing dental conditions?

Marketplace pediatric dental plans must cover pre-existing conditions without any benefit cap or waiting period, as pediatric dental is an essential health benefit (EHB). CMS has clarified that all EHB must be covered without waiting periods,²⁹ and Marketplace plans’ coverage of EHB cannot discriminate based on an enrollee’s medical history.³⁰

But adult dental coverage is not considered an EHB, and thus does not have the same regulatory guardrails. So insurers that offer Marketplace dental plans can and often do have pre-existing condition exclusions and/or waiting periods for adult dental coverage,³¹ unless a state prohibits this. For example, stand-alone adult dental plans sold through New York’s state-run health insurance exchange cannot have waiting periods for any services other than orthodontia.³²

How can I compare dental plans offered on my state’s exchange?

The specifics vary a bit depending on whether you’re in a state that uses HealthCare.gov or a state that runs its own Marketplace. But all of them have plan comparison/shopping tools that allow you to enter some basic information (age or birthdate, zip code, and income) and see quotes for plans available in your area.

Depending on where you live, some of the medical plans may include embedded dental coverage. But you’ll also be able to see stand-alone dental plans, usually by selecting from a drop-down menu or toggling between medical and dental plans.