The ACA’s Impact on Dental Insurance: What You Need to Know

The Affordable Care Act (ACA) has far-reaching implications for healthcare coverage in the United States. One aspect of the ACA that has been the subject of much discussion is its impact on dental insurance.

Dental Coverage Under the ACA

The ACA does not mandate dental coverage for adults. However, pediatric dental coverage is considered an essential health benefit and is required to be included in all health insurance plans offered to children under the age of 19.

ACA and Dental Insurance Limits

For adults, dental coverage is considered non-essential, and insurance companies can place limits on the coverage they provide. These limits can include:

Annual maximum benefits: This is the maximum amount of money an insurance company will pay for covered dental services in a calendar year.
Deductibles: A deductible is the amount of money you have to pay out-of-pocket before your insurance coverage begins. Dental insurance deductibles can vary widely, from $50 to $250 or more.
Coinsurance: Coinsurance is the percentage of the cost of covered dental services that you are responsible for paying after you meet your deductible. Common coinsurance rates for dental insurance are 20%, 30%, or 50%.

Types of Dental Insurance Plans

There are several different types of dental insurance plans available, each with its own set of benefits and limitations.

Dental HMOs (DHMOs): DHMOs offer a limited network of dentists and require you to get a referral from your primary care dentist before seeing a specialist. DHMO plans typically have lower premiums than other types of dental insurance.
Dental PPOs (DPPOs): DPPOs offer a wider network of dentists than DHMOs and allow you to see any dentist in the network without a referral. DPPO plans typically have higher premiums than DHMOs.
Dental indemnity plans: Dental indemnity plans give you the most flexibility in choosing your dentist and the treatments you receive. However, these plans also typically have the highest premiums.

Finding the Right Dental Insurance Plan for You

If you are considering purchasing dental insurance, it is important to compare plans from different providers to find a plan that meets your needs and budget. You should also consider the following factors:

The coverage you need. Do you need a plan that includes orthodontic coverage? Do you have any pre-existing dental conditions that you need to be covered?
The cost of the plan. How much can you afford to pay for a monthly premium?
The network of dentists. Do you want a plan that offers a large network of dentists, or are you willing to trade off network size for a lower premium?

To find the best plan for you, it is always a good idea to contact licensed health insurance agents. They have access to multiple plans and options, and they can help you find a plan that meets your needs and budget.