Open Enrollment Tips, Part 3: Should I Choose A Dental Plan?

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After you choose a health insurance plan on the Marketplace (healthcare.gov), you generally will get a screen that says that dental insurance is not included. Would you like dental insurance?

If you answer yes, you will be directed to look at some of the dental insurance plans on the Marketplace.

How does individual dental insurance work?

In general, individual dental insurance is similar to individual health insurance in two ways:

  1. You pay a monthly premium.
  2. Preventive care (cleanings and x-rays) are covered 100% and are encouraged. Other procedures will be covered at different percentages (50%, 80%, 100%) depending on the procedure, the dental network, and the company. Just like with most health insurance, dental insurance works with a "network" of providers, and out of network providers may be covered at a much lower cost, or not at all.

Individual dental insurance is different from individual health insurance in two ways.

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  1. More significant procedures (fillings, crowns, extractions, root canals, bridges, dentures) often have a waiting period of 6 or 12 months before you can use the benefit. 
  2. Most individual dental insurance has a maximum dollar amount that can be spent on you in any year. This is the opposite of medical insurance, where once you hit a maximum out of pocket costs, everything is covered.  With dental insurance, if you need a couple of expensive procedures, you will likely hit the point where the dental insurance has maxed out.

 

Can you use tax credits for dental insurance on the Marketplace?

In general, no. Dental coverage is an essential benefit for children under the age of 18. If it is not included in their health plan then you can use tax credits (if you have any left over) toward their dental plan.  Adults cannot use tax credits to buy dental insurance.  Marketplace dental information.

Are there other options?

Yes, there are (at least) three other options.

1. Take employer-offered dental insurance. If you are buying health insurance on the Marketplace because your employer health insurance is unaffordable, their dental insurance may still be affordable--and may not have the waiting periods that individual dental insurance has. You can only choose this during employer open enrollment or a special enrollment period.

2. Buy off the Marketplace. Since you are not using tax credits, you should look around. You can work through an insurance broker or directly with companies that offer dental plans like Blue Cross, Delta, Golden, etcetera. You can only do this during Marketplace open enrollment or when you qualify for a special enrollment period.

3. Set money aside each month for dental expenses as if you were paying a dental premium. Call around to find a dentist you like and who is affordable. Dentists' rates vary. Pay out of pocket for cleanings, fillings, etcetera. [You can also use money from a health savings account or flexible spending account to cover dental expenses.] You can choose this any time of year.

Read more about dental care, insurance and coverage here.

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