Under Obamacare (Affordable Care Act/ACA), you may have some questions about what is required of you. You know that you are required to hold health insurance, or minimum essential coverage, throughout the year or potentially be subject to a tax penalty. That said, you may be wondering if the same applies to dental coverage, and the answer is no. Although it’s not required, it is certainly still a good idea, as dental procedures can be pricey when they’re full price. If you’re shying away from dental insurance but still looking to save some money on dental work, there’s another option that people aren’t always aware of. These alternative solutions are called dental discount plans and since they’re less commonly known, we’ll give you the details on how they work first!
Dental Discount Plans vs. Dental Insurance
A dental discount plan charges a yearly fee, which gives you access to pre-negotiated discounts with dental providers. Though this is paid once a year, if broken into 12-month payments like dental insurance, dental discount plans tend to be much less expensive.
Unlike dental insurance, there are no copays, deductibles, or coinsurance, or monthly premiums that you are responsible for. Upon your visit to the provider, you give them your discount card, they tell you the adjusted price for your service(s), and you pay them directly.6
Another difference between a dental discount plan and insurance is the time you must wait to have a procedure covered. Dental insurance will typically cover small, preventive services right away, but requires a waiting period until anything major will be covered, like root canals, crowns, etc. Many dental discount plans will give you your discount on these major (and minor) services immediately with no waiting required. If you’ve got a tooth in need of some serious work that can’t wait, a dental discount plan is a great choice.6
Seek In-Network Care
There is one similarity between the two dental coverage options, though, and that’s the use of networks. Each coverage option contracts with a network of providers, so just as you would with dental insurance, you would need to go to an in-network provider when seeking care with your discount plan.
The choice is yours, but if you’re looking to save money on what you pay per month and only pay once a year instead, a dental discount plan may be a good choice for you. It may also be a solid option if you’re looking to have major work done on your teeth as soon as possible. With no waiting periods, you can get that work taken care of right away!6
Dental Insurance and the Health Insurance Marketplace
If you have decided a dental discount plan isn’t for you and you’d like to get yourself dental insurance, and are using the Marketplace to do so (healthcare.gov), there are two ways in which this is available to you:2
Dental Insurance Included in Health Plan
Some major medical insurance plans come with a dental plan already built in. This means that you would only pay one premium a month, which would include both your health and dental coverage.
Stand-alone Dental Insurance Plans
Some major medical plans do not automatically include dental insurance, but you may still want it. With a stand-alone plan, you can keep your health insurance plan, and purchase dental insurance separately. Another reason for stand-alone plans is if your health plan comes with dental insurance, but you want a different plan whose benefits may suit you better.
It is important to note that when purchasing dental insurance through the Health Insurance Marketplace, you must also be purchasing a health plan. In other words, it is not possible to just go to the Marketplace and only purchase dental insurance- you must be enrolling in a health plan at the same time.
Dental Insurance Categories
When considering dental insurance, you should know that there are two main categories for the plan you choose- similar to health insurance- high and low coverage levels.2
High Dental Insurance
This type of dental insurance offers lower copayments and deductibles, with higher monthly premiums. You will pay a higher price each month, but when dental services are actually used, you will pay a lower price.
Low Dental Insurance
Opposite of the high coverage level, a low coverage level requires higher copayments and higher deductibles with lower premiums every month. This means that should you need dental services, you will be paying more due to your copay and deductible, but less on a monthly basis for your premium.
Types of Dental Insurance
Once you have decided to enroll in a dental insurance plan and picked your desired coverage level, you’ll next have different types of dental insurance to choose from. Below is a brief summary of the three most common types.1
To many, this is just known as traditional dental insurance. This type of coverage allows individuals to get dental services from any provider. There are no network provisions, and consumers will be reimbursed for a specific amount of the services that were provided. The insurance provider would pay a pre-specified amount for the service as dictated by the policy, and the consumer is responsible for paying the difference.
Preferred Provider Organization (PPO)
This type of insurance works with a contracted network of dentists, who will deliver services for pre-determined, set prices indicated in their contract with your dental insurance provider. Choosing a dentist who is out-of-network, or not in the contract will likely result in paying higher prices out of pocket, because they have no contract with agreed upon pricing.
Dental Health Maintenance Organization (DHMO)
Contracted dentists are “pre-paid” each month for each patient that the insurance company has designated to them. That dentist will then provide services at reduced or no cost to those specific patients. The patient typically must visit the contracted dentist in order to receive the reduced or no cost service, or risk paying a high out of pocket price from a non contracted dentist.(HMO’s typically have no out of network benefit)
Additional Dental Insurance Information
Cost Assistance for Dental Plans
Stand-alone dental plans do not qualify for a tax credit. However, when enrolling in a major medical plan that also includes dental, any tax credit can be applied to that premium.2
Dental Coverage for Children
Under Obamacare, when insurance is purchased for someone under the age of 18, dental insurance must be available as essential coverage. However, dental insurance is not required for children, and you will not be charged a tax penalty should you choose not to accept the dental insurance for a child.2
Cancelling Dental Insurance Through the Marketplace
If you are enrolled in a dental policy through the Marketplace, it may be cancelled at any time if it is a stand-alone policy. If you have dental coverage that is included in your health plan, you cannot cancel or modify that plan until the open enrollment period, November 1, 2015- January 31, 2016 (for this year). Outside of this period, you may only change your health plan if you have a qualifying life event or if you cancel the major medical plan. You can cancel the plan if you cancel the major medical.2
- 4 billion people worldwide have untreated cavities: Study. Retrieved October 1, 2015, from https://consumer.healthday.com/kids-health-information-23/cavities-and-dental-news-118/4-billion-people-worldwide-have-untreated-cavities-study-676918.html
- Dental benefit plan models. (n.d.). Retrieved August 31, 2015, from American Dental Association website: https://www.ada.org/en/public-programs/dental-benefit-information-for-employers/dental-plan-benefit-models
- Dental coverage in the Marketplace. (n.d.). Retrieved August 31, 2015, from HealthCare.gov website: https://www.healthcare.gov/coverage/dental-coverage/
- Endodontic facts. Retrieved October 1, 2015, from American Association of Endodontists website: https://www.aae.org/about-aae/news-room/endodontic-facts.aspx
- Facts & figures. Retrieved October 1, 2015, from GoToAPro website: https://www.gotoapro.org/news/facts–figures/
- Smith-Dewey, C. (2015). Dental insurance vs. dental discount plans: The ‘tooth’ about options for
grinding down dental bills. Retrieved December 8, 2016, from