The following resources will help you understand your Delta Dental plan options under the Affordable Care Act (ACA):
When it comes to the Health Care Exchange (Marketplace), we’re experienced, knowledgeable and proactive. We’ve developed straightforward, ACA-compliant1 dental plans to help you get the coverage you need. With a Delta Dental plan, you’ll enjoy:
Review, compare and purchase the right Delta Dental plan for you and your family through our website, your state exchange or your insurance agent.
Children’s dental benefits under the ACA as of 2014 include three types of arrangements:
General information to help you shop and compare plans is below. Coverage in your state may differ somewhat, depending on how state regulators and exchanges set their rules and policies.
Embedded pediatric dental benefits are included (embedded) in the medical policy. This means that:
Choosing only an embedded plan (a medical plan that includes the EHB pediatric oral care requirement) may appear to be the easiest way to meet the ACA requirement; however:
For the reasons noted above, if you have an existing traditional family dental plan, it may make sense to keep it, in addition to the high-deductible embedded dental plan you may get from your health plan.
Bundled dental and medical policies are sold together, but as two separate policies. Delta Dental has partnered with several medical carriers to offer bundled coverage that meets ACA requirements.
There are federal rules governing the cost sharing3 of bundled dental coverage, which make it a good choice for meaningful dental coverage. Bundled coverage includes:
Stand-alone dental coverage includes the same rules and advantages as bundled coverage described above, offering separate, limited deductibles and out-of-pocket maximums. Stand-alone coverage can be coupled with a medical policy that does or does not include pediatric dental.
In most states, you can purchase a stand-alone plan to accomplish any or all of the following options, depending on your family’s needs:
Please note: Children with dental coverage through a family member’s employer are not required to have dental coverage under the ACA.
|Your situation||How to get (or keep) a Delta Dental plan||Your Delta Dental plan choices*|
*Plan provisions and availability will vary from state to state, depending on each state's specific rules and regulations.
|You have a Delta Dental plan for yourself, your child/children and spouse through a large employer (100+ employees).||
Large employers handle most of what needs to be done to comply with the ACA, so there's likely nothing more you need to do.
Your employer provides your plan choice(s). You should get more details during your next open enrollment period.
|You have a dental plan for yourself, your child/children and spouse through a small employer (fewer than 50 employees until 2016, when a small group is defined as fewer than 100 employees).||
Speak to your employer about retaining your current dental benefits and/or adding an ACA-compliant Delta Dental pediatric dental policy to your existing policy. Generally, your employer and/or existing health plans will make the changes needed.
Through most state exchanges, you can compare and purchase the following types of ACA-compliant plans for yourself, children up to age 19 and/or the whole family:
Online or through an insurance agent, you have several options:
|You want to purchase a dental plan on your own for yourself, your child/children and spouse.||
Under the ACA, any medical coverage you purchase includes pediatric dental care for children up to age 19. So, your children will have this dental coverage “embedded” into the medical plan. Embedded coverage will often come with a high combined medical/dental deductible (as high as $2,000 per person, per year or higher), making it difficult to actually benefit from the dental coverage.
You can fill the gaps that come with embedded pediatric coverage (and add coverage for adults and dependents ages 19 to 26) with a Delta Dental plan.
|You want to purchase a dental plan on your own for yourself only.||
You can purchase a plan in these ways:
|You want to purchase only what is required by law.||
Under the ACA, any medical coverage you purchase as an individual includes dental care for children to age 19. You are not required to purchase additional or separate dental coverage for children or adults.
Still have questions about finding or purchasing an ACA-compliant dental plan? Call our Health Care Exchange (Marketplace) Plans Customer Service.
Monday through Friday between 7:15 a.m. and 7:30 p.m., Eastern Time