While dental benefits sold in stand-alone policies (not part of medical policies) are generally not subject to most ACA requirements, there are some exceptions. Pediatric dental benefits (for those under age 19) are part of the Essential Health Benefits Package (EHB), which must be offered and meet state-specific benefit standards. Some administrative contracts for larger employers are also impacted.
- Ambulatory patient services
- Prescription drugs
- Emergency services
- Rehabilitative and habilitative services and devices
- Laboratory services
- Maternity and newborn care
- Preventive and wellness services and chronic disease management
- Mental health and substance use disorder services, including behavioral health treatment
- Pediatric services, including oral and vision care
Also, for the most part, plans cannot impose annual or lifetime maximums (aka limits) on these services.
Is orthodontia covered under the Pediatric Dental Benefit?
The minimum standard is for orthodontia declared “medically necessary” to be covered. Some plans may offer additional or supplemental coverage for cosmetic orthodontia.
Will my health insurance cover dental?
Some health insurance plans may include “embedded” or “bundled” dental plans. It is important to understand how those benefits work, including the deductible. If you purchase a dental plan embedded with a medical plan, you may be required to pay the full medical deductible before dental services are covered. Stand-alone dental plans are available from Delta Dental both inside and outside the Marketplace.
Do I have to see a specific dentist for care?
Individuals who purchase individual or small-group dental coverage, inside or outside the Marketplace, will need to see a dentist that participates in that plan’s network to maximize their benefits. The limits on out-of-pocket costs may not apply to out-of-network dentists.
Are the adult and pediatric benefits different?
Adults purchasing dental benefits through the Marketplace may have different benefits than their children/dependents who are under age 19 and are enrolled in a Pediatric Dental Plan. With Delta Dental benefits, you will be able to see the same network dentist for care, if you prefer.
Am I really covered if dental is included with my health benefits?
Dental benefits may be embedded in a medical plan. However, medical deductibles are often much higher than dental, and non-preventive dental expenses may not be covered until the medical deductible is reached. Even if benefits are embedded, you may want to check your options with a supplemental individual dental plan.
How do I purchase dental benefits from Delta Dental of Kansas?
At Delta Dental of Kansas, all plans offered in the Marketplace are also offered outside the Marketplace. View Delta Dental of Kansas' exchange-certified plans.