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Is dental insurance considered health insurance?

The lowdown...
    • Dental insurance does not count as qualifying health coverage under the Affordable Care Act because it does not meet the minimum essential coverage guidelines
    • If you are only covered by dental insurance, you may be responsible for paying the individual mandate penalty fine
    • If you are purchasing a health plan through the marketplace, you can either get dental insurance as part of your health plan or separately
    • You can only buy a dental plan on the marketplace if you are also buying a health plan
    • All plans that insure children under 18 must offer them dental coverage

Dental insurance is not considered qualifying health insurance under the Affordable Care Act guidelines.

Vision only and dental only plans will not exempt you from the individual mandate fine. However, some marketplace plans include dental insurance, in addition to the other health benefits they offer.

If you are looking for affordable health insurance and dental insurance, start comparison shopping today by entering your ZIP code above!

What is qualifying coverage?

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A qualified health plan must provide coverage for the ten essential health benefits and adhere to the cost-sharing maximums for deductibles, co-payments, and monthly premiums. Employer-based plans must also meet affordability rules and the minimum value standard, which requires that the insurance plan pay at least 60 percent of the average person’s medical costs.

Other requirements must be met under the Affordable Care Act guidelines. The essential health benefits include:

  • Ambulatory and emergency services
  • Mental health care
  • Maternity
  • Newborn
  • Pediatric services
  • Lab tests
  • Rehabilitative services
  • Prescription drugs
  • Preventive services

Plans must also include birth control and breastfeeding coverage if they come from the healthcare marketplace.

What happens if I only have dental insurance?

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If you are only enrolled in a dental insurance plan, you may be responsible for paying the individual mandate penalty fine because you do not have adequate coverage.

The annual fine for 2016 is calculated in one of two ways.

It will either be $695 for each adult and $347.50 for each child with a maximum amount of $2,085 or 2.5 percent of your household income.

You will be responsible for paying whichever of the two is greater. It is an annual cost, so you will pay 1/12th of the total for each month that you went without coverage.

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If you went without adequate health insurance for less than three consecutive months, you may be eligible for the short coverage gap exemption and not have to pay the individual mandate penalty fine.

Additionally, there are other exemptions you may qualify for. If your income is less than the tax filing limit or if the least expensive plan available to you is still more than eight percent of your total household income, you may qualify for an exemption.

How do I get dental coverage?

Even though it is not qualifying health coverage on its own, you may still want to purchase dental insurance to help cover your dental costs. You can buy a dental plan from the health care marketplace in one of two ways.

You can only purchase dental coverage in the market when you are also enrolling in a health plan at that moment.

Some health plans have dental coverage included. When you are looking at health plans, you will be able to see which ones offer dental coverage when you are looking through their list of benefits. You will only have to pay one monthly premium amount for both your health care and dental care.

If the health plan you choose does not have dental coverage or you want a better dental plan, you can purchase two separate plans for health and dental. You will then pay two separate premiums.

There are two types of dental plans available for purchase in the marketplace — high and low coverage.

High coverage has higher monthly premiums but lower deductibles and co-payments. You will pay less when you are using your dental services even though your monthly costs are higher.

The low coverage has lower monthly premiums, but you will pay more for your dental services.

You typically will not be offered cost assistance for a stand-alone dental plan, but you might for a health plan that also offers dental. If your health insurance company offers you dental insurance, you should consider taking it since they contribute to your monthly premium.

Will my children have dental coverage under my health plan?

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Dental coverage for children under the age of 18 is considered an essential health benefit under the Affordable Care Act guidelines. Dental coverage must be available to children in this category.

It can be a part of your existing plan or a separate plan. However, it is not mandatory that you purchase it for your children, just that it is available to them.

You will not be required to pay the penalty fine if your children do not have dental insurance. Insurance companies do not have to offer dental insurance to adults at all.

How do I cancel my dental plan?

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If you want to cancel a dental plan, you have options depending on the type of dental plan you have.

If you have a separate dental plan, you can just stop paying your monthly premium, and the insurer will drop you. You should stop paying your premium instead of removing the plan on your healthcare marketplace account, because this will remove both your health and dental plans.

If you have a health plan with dental insurance, you will have to wait until the open enrollment period to change to a plan without dental.

Dental insurance is not considered qualifying health coverage. However, it can be a helpful tool to lower your dental costs.

It is an essential health benefit for children under the age of eighteen, but not for adults. There are two types of health coverage available for purchase on the healthcare marketplace.

Looking for health and dental coverage? Enter your ZIP code below to start comparison shopping for better rates today!

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