Dental Insurance Coverage and the Affordable Care Act

The Affordable Care Act considers dental coverage for children an “essential health benefit.” This means that in order for a health plan to be ACA compliant, it must include pediatric dental coverage or be available through a standalone plan. All of Guardian’s plans include the pediatric essential health benefit, and these services are covered without annual or lifetime limits when care is received in-network.

This rule applies to anyone under the age of 19, so while your high schooler may not consider themselves a child, healthcare.gov does!

While dental insurance isn’t required benefit for adults under the Affordable Care Act, dental care is a very important part of your overall health and wellness of you and your family.

Just like health insurance, dental insurance works by paying for a portion of your dental care costs in return for a monthly fee, called a premium. While proper dental hygiene, much like good diet and exercise, can help you keep a healthy mouth and a health body, there are always emergencies. (And don’t forget about regular dental visits for checkups and cleanings!) Even the most basic dental procedures have costs associated with them, and without dental insurance, you could be on the line for the full cost out-of-pocket!

Dental Coverage on the Exchange

The fact that adult dental coverage is not a required benefit for plans does not mean you can’t find great dental coverage for you and your family there. Through healthcare.gov, you can get dental coverage as part of a health insurance plan or through stand-alone plans, like those offered through Guardian.

Marketplace Dental Plan Categories

On healthcare.gov and state exchanges, dental plans are divided into two categories: Low coverage and High coverage. You’ll be able to see the details about plan cost when you compare plans on the Marketplace.

High Coverage

High coverage plans have higher premiums, but lower co-payments and deductibles.

This means you pay more for the plan each month, but you’ll pay less when you visit the dentist or have work done.

Low Coverage

Low coverage plans have lower premiums, but higher co-payments and deductibles.

This means, you pay less for the plan each month, but you’ll pay more when you visit the dentist or have work done.

Dental Insurance is Important

Dental insurance can make an immediate difference in your life, because the majority of plans cover regular check-ups with your dentist. It’s during these regular visits that your teeth are cleaned and any emerging problems can be caught before they get out of hand and overly expensive. Don’t put off your dental health for another day!

Something to remember: you can’t get a dental plan through the marketplace unless you’re also enrolling in a health insurance plan at the same time. If you’re in need of dental insurance but already have health insurance, you can get a quote directly from Guardian!

Learn More About Guardian

Guardian has been a trusted name in insurance for over 155 years. Today, we have one of the largest dental insurance networks in the country and our dentists can help you save up to 35% on the dental care you need* Learn More About Guardian »

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