The Affordable Care Act and Dental Care For Children

The ACA specifies that dental care for children is an “Essential Health Benefit.” That may sound like having some sort of dental coverage—insurance or otherwise—is required for kids by law. But what it really means that pediatric dental coverage must be available for purchase in the ACA Marketplace. Parents don’t have to purchase dental insurance under federal law. 

In the federal and state run Marketplaces, pediatric dental plans are available as part of a health care plan, as a bundled offer or as a stand-alone plan. In the federal Marketplace, you cannot purchase a stand-alone dental plan without purchasing health care insurance. Stand-alone dental plans are not covered by federal subsidies. 

A few states do or are considering making kids’ dental coverage mandatory. If your state runs its own Marketplace, it will also determine other variables like deductibles, co-pays, and co-insurance.   

Taking care of your kids’ dental needs 

Despite the passage of the ACA, purchasing dental insurance and/or paying for care is a struggle for many families. Tooth decay remains one of the most common chronic conditions among children, according to the Centers for Disease Control and Prevention (CDC). 

The CDC states that “about 23% of children ages 2 to 11 years have at least one primary tooth with untreated decay, and 20% of adolescents ages 12 to 19 years have at least one permanent tooth with untreated decay.” Approximately a quarter of U.S. children do not have dental insurance, either private or public. 

Dental care for Medicaid and CHIP enrollees 

States are required to provide dental benefits to children covered by Medicaid and the Children’s Health Insurance Program (CHIP). 

Medicaid covers dental services for all enrolled children as part of the set of benefits, referred to as the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.  The EPSDP states that all services must be provided if determined medically necessary, with states determining medical necessity. 

If dental needs are discovered during a checkup the state must provide services to treat that condition, whether or not it is included in a state’s Medicaid plan. Minimum guidelines for dental services must include: 

• Relief of pain and infections 
• Restoration of teeth 
• Maintenance of dental health 

States are also required to post a listing of all participating Medicaid and CHIP dental providers and benefit packages on www.insurekidsnow.gov. 

Are my children eligible for Medicaid or CHIP? 

Part of the enactment of the ACA involved transitioning Children’s Health Insurance Program (CHIP) enrollees into Medicaid. Individual states are able to determine how to handle this transition. See if your children qualify to receive assistance. 

Dental savings plans for families 

Dental savings plans offer an affordable and sensible way for families to pay for dental care. These plans are a trusted alternative to traditional dental insurance and provide discounts on virtually all procedures. Plan members report saving an average of 50%* on their dental care.  

Unlike dental insurance, dental savings plans have no annual spending limits (dental insurance typically restricts you to $1,000-$1,500 per year). If you just need basic care like checkups and cleanings, dental insurance may be all you require. But if the kids need braces, or a family member needs a root canal and crown, you can burn through your dental cap for the year in just one visit to the dentist.  

Additionally, many families assume dental insurance will make braces affordable. But, along with the annual spending limit, many insurance plans also typically have a lifetime limit for orthodontia care – the total amount insurance will pay towards any orthodontic treatment – which is typically $1,000-$3,000. The typical cost for under-18 orthodontic treatment is $6,000.  

Dental savings plans offer deep discounts (20%-25%) on the cost of orthodontics. Select dental savings plans can reduce the cost of braces by 39-48%.  

And with a dental savings plan you can start saving at the dentist right away (plans activate 72 hours after joining), so unlike dental insurance there’s no need to wait to get discounts on your dental services. Many plans even include cosmetic dental procedures such as teeth whitening and overlays. 

It’s simple to choose a dental saving plan at DentalPlans.com, the largest marketplace for dental savings plans and dental insurance. You can compare more than 25 plans from the most trusted brands in healthcare, and easily join your selected plan. And if your dental needs change, your dental savings plan can too.  

Want a personalized recommendation? Give us a call at 1-833-735-0399, we’d be happy to help you find the plan that fits your budget and gives you the best savings on quality dental care for your family. Want a quick peek at how much you can save? Use our calculator below.  

* Discount Health Program consumer and provider surveys indicate average savings of 50%. Savings may vary by provider, location, and plan.