Does the Affordable Care Act Cover Dental?

Does Obamacare Cover Dental?

Not too long ago, dental insurance was thought of as a luxury item. Some people still view it this way. However, as we’re given more and more information about how our oral health connects to our overall health and well-being, the interest in dental insurance has increased.

Many people want to know if Obamacare, also known as the Patient Portability and Affordable Care Act (or ACA for short), includes dental coverage. The simple answer is yes, but we need to dive a little deeper into the question to make sure you know what you’re looking for when searching for dental coverage through Obamacare.

Obamacare Coverage: Childrens vs. Adults

Every plan within the ACA must include ten essential health benefits. One of those essential health benefits is pediatric services, which include dental and vision treatments. Dental insurance must be available for anyone who is 18 years old or younger. It could come as part of the primary health plan or as a separate policy. Still, while it must be available, you are not required to purchase it. Dental (or vision) insurance is not an essential health benefit for adults over the age of 18. Health plans do not have to offer adult dental insurance as part of their coverage.

If you purchase a separate dental insurance plan as an adult, you will pay an additional premium for that coverage. The premium amount depends on the plan and how much coverage you’ve selected. Also, you must be enrolled in a health plan to be eligible to purchase a dental plan.

Obamacare Dental Insurance: Benefits

The health insurance portion of Obamacare is broken down into metal tiers: Platinum, Gold, Silver, and Bronze. The dental insurance portion is simplified even more, with just a “high” or “low” option.

The high option has higher premiums and higher coverage. That means you’ll pay more to have the coverage but will pay less when you receive treatment. Contrarily, the low option has lower premiums and lower coverage. You pay less per month for the policy but have less coverage and more out-of-pocket costs for dental services. Your annual deductible will also be higher with the low option.

You’ll need to compare the following aspects of coverage to determine which plan is the best fit for you.

Annual Maximum: This is the maximum amount the plan will pay in a benefit or calendar year. Once the plan has paid the maximum benefit, any costs for additional services are the responsibility of the insured. Some plans do not include preventive benefits (cleanings, x-rays, and exams) as part of their annual maximum.

Annual Deductible: This is the amount you must pay before coverage begins. Some plans waive the deductible for preventive care.

Services Covered: Dental services could include preventive (routine), basic, major, and orthodontia. Not all services are part of every plan’s benefits.

Cost-Sharing: This comes in the form of either a copay (flat-rate) or coinsurance (percentage) amount. Most plans use coinsurance instead of copays. For example, if you have 80% coverage for fillings, your responsibility will be 20%.

Networks: All dental insurance plans use provider networks. Some plans only cover treatment if it is performed by an in-network dentist. Other plans have out-of-network coverage, but you will be responsible for more cost-sharing. Using the previous example, if you have 80% coverage on fillings done by an in-network dentist, you might only have 60% coverage if they are done by a non-contracted dentist.

Obamacare Dental Insurance: Cost

Monthly premiums for ACA dental plans are based on various factors. Annual maximums, deductibles, cost-sharing, and networks all play a part in determining the plan’s premium.

Premiums are higher for plans with:

  • Higher annual maximums
  • Lower deductibles
  • Lower cost-sharing
  • Out-of-network benefits

If you are looking for health insurance in Austin, Texas, you’ll be able to find dental plans that range from $10 per month to more than $60 per month. You’ll have quite a few options to consider, so start by asking yourself the following questions:

  • How much can I afford?
  • What dental treatment do I know I need? (Has your dentist already recommended treatment?)
  • Is my dentist in-network with the plan? If not, am I willing to change providers or pay more for services?

These questions will help you narrow down your options to a handful that meet your requirements.

Our team of insurance agents can help you find health insurance in Texas. We work with many different insurance companies, including ones that offer Obamacare plans. We’ll take the time to get to know you and find out what type of coverage you’re looking for. Then, we’ll search for plans that meet your needs and budget. There is no cost to work with us, so why do all that research yourself? Contact our office today and schedule your consultation.