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Obamacare Premiums on the Rise and Dental Options Limited

:DentalPlans’ Guide to Purchasing Dental Coverage Under the Affordable Care Act

Plantation, FL 33324 (November 01, 2016)

Obamacare Open Enrollment has begun - premium prices have increased and dental care selections remain limited. It is important to be informed about any changes and available options. Americans who purchase their health insurance through the Affordable Care Act (ACA) Marketplaces have until January 31, 2017 to choose their healthcare plan or switch to a new one.

The average premium prices for Obamacare are expected to rise 22-25%, but subsidies that help lower income people pay for their health plans have also risen. Additionally, the number of insurers participating in the federal market have dropped significantly from 232 in 2016 to now 167 in 2017, according to

According to a 2015 :DP SmileIndex® survey, a survey on oral care access and affordability, 31% of respondents who had medical insurance thought Obamacare made healthcare more costly. And, 42% of the same respondents, especially those married with children, mentioned a noticeable increase in costs compared to what they paid the previous year. Two years later and with premiums on the rise, it is expected that plan members will greatly feel the cost impact.

"The price of Obamacare and limited dental options are going to make it difficult for people to get the care they need, forcing many of them to choose between their health and other priorities," said Bill Chase, vice president of marketing for :DentalPlans. "Unfortunately, many people will put off their own healthcare needs, like dental, until they need an expensive procedure or are in a lot of pain."

Is Dental Insurance Required for Children?
Pediatric dental services are listed as an essential benefit under the ACA, but there is no federal law that requires dental care for kids to be included in an ACA-accredited healthcare plan. When it comes to dental insurance "essential," only means "available for purchase."

  • If purchasing a plan through the federally-run Marketplace, one is not legally required to purchase dental insurance for their children.
  • But for those who live in California, Connecticut or Washington State and buy a family plan from the state-run Marketplace, their plan must include pediatric dental coverage.
  • If a plan is purchased through the private market, one may need to either purchase dental insurance (whether they have children or not) or provide reasonable assurance that they have purchased it or intend to do so. They can also ask their broker about options available to them.

Is Dental Insurance Required for Adults?
Dental care for adults is not considered an Essential Health Benefit under the ACA and there are very few dental coverage options available through the Marketplace for adults.
If one purchases dental coverage for their children on the Federal or State Marketplaces, they may be able to add adult members of the family to their pediatric dental plan. It is recommended that they review the plan's coverage carefully, as adult benefits are likely to be very limited.

Issues to be Aware of When Purchasing ACA Dental Coverage:

  • One cannot purchase just dental insurance on the ACA Marketplaces – they must simultaneously purchase a health plan.
  • If one's health plan does not include dental, a standalone plan can be purchased. However, if a standalone plan is purchased by someone, they will not be eligible for a federal subsidy to reduce the dental plan's cost.
  • A healthcare/dental bundle does qualify one for federal subsidies, but healthcare plans that include dental may have a large deductible that applies to dental as well as medical care. According to an analysis of 2017, plans available on the ACA Marketplace indicate that the average deductible is $5,731 for individuals and $11,601. However, families and individuals will have to pay out of pocket for most dental care until they meet their deductible. It is recommended that one finds a dental insurance plan that offers a separate, lower deductible for dental care.
  • Orthodontic care, and other services like dentures and implants, may not be covered by every plan.
  • Preventative dental care is provided at 100% - at no charge- on Obamacare pediatric dental plans. But this coverage may be limited to the bare minimum of preventive care. Cleanings, x-rays and other basics are not legally required to be included if dental coverage is embedded in one's health plan.

ACA coverage may not meet everyone's dental care needs, but there are other ways in which they can get the care they are looking for. Dental savings plans offer an affordable alternative to dental insurance. With a dental savings plan, members gain access to a network of dentists who have agreed to offer reduced rates to plan members – typically 10%-60% of the cost of virtually all dental care and treatments.

And, with a dental savings plan, there are no health restrictions or annual limits. Members can save on every visit and avoid paperwork hassles. They simply pay the discounted rate directly to their dentist.

Find out more about dental savings plans on

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For more information:

Call 833-742-5097 or Email [email protected]

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