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The following resources will help you understand your Delta Dental plan options under the Affordable Care Act (ACA):

Why choose a Delta Dental plan?

When it comes to health care reform, 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:

  • Quality coverage for children, yourself and/or the whole family
  • Benefits that focus on preventive care to keep teeth and gums healthy
  • Large dentist networks — you may not have to change dentists
  • Great customer service

Review, compare and purchase the right Delta Dental plan for you and your family through our website, your state exchange or your insurance agent.

Three types of pediatric dental coverage

Children’s dental benefits under the ACA as of 2014 include three types of arrangements:

  • Embedded
  • Bundled
  • Stand-alone

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

Embedded pediatric dental benefits are included (embedded) in the medical policy. This means that:

  • A single deductible with no annual limit may apply to both the dental and medical benefits together. For example, a deductible of $2,000 per individual ($4,000 per family) or higher may have to be met before your child is eligible for dental benefits. Some medical plan carriers might waive this deductible for dental, waive just for diagnostic and preventive services, or establish a separate deductible for dental; others may not.
  • A combined medical-dental contractual out-of-pocket maximum2 could be up to $6,600 per individual and $13,200 for families. Once the out-of-pocket maximum is reached, the dental/medical policy would provide 100% coverage.

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:

  • The dental portion likely won’t cover adults or children age 19 and over
  • Dental expenses may not be covered until a high combined medical/dental deductible is met, which can be as high as $2,000 per person annually or higher
  • Your family dentist may not participate in the dental plan embedded in your medical policy

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

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:

  • Separate deductibles and out-of-pocket maximums, which are not affected by the medical coverage; for example, the deductible for dental will generally run from just $35 to $130, after which a typical dental benefit plan structure applies.
  • No annual benefit maximums on pediatric benefits, but a separate out-of-pocket maximum never to exceed $350 for a single child and $700 for multiple children will determine when the policy begins to pay 100% of covered in-network services.
  • Dental benefits must be designed to meet federally required actuarial values of 70% or 85%.

Stand-alone

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:

  • Provide the required EHB pediatric dental coverage for children up to age 19
  • Provide additional coverage to fill gaps in the dental benefits that come embedded in a medical policy (such as a high deductible)
  • Provide dental coverage for older children (ages 19 to 26), yourself and/or your spouse

Please note: Children with dental coverage through a family member’s employer are not required to have dental coverage under the ACA.

Your plan choices

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:

  • Stand-alone Delta Dental plans.
  • Separate medical and Delta Dental plans, bundled together, through one of our medical carrier partners.
  • Medical plans that include pediatric dental coverage (embedded plans) will not cover adults or children ages 19 to 26 (consider stand-alone and bundled plans to fill the gaps that come with an embedded plan by adding coverage for adults, children to age 19 and older dependent children).

Online or through an insurance agent, you have several options:

  • Individual (adult) dental plans; no ACA requirements apply.
  • Plans that exclude coverage for children under age 19 (because their coverage is embedded in the medical plan) but do cover you, your spouse and/or older dependents.
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:

  • Through most state exchanges
  • Outside of exchanges directly from Delta Dental
  • Through an insurance agent
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.

  1. 1ACA-compliant health plans include the required 10 essential health benefits (EHBs), one of which is pediatric oral care to age 19.
  2. 2An out-of-pocket maximum is the amount an enrollee pays for services (a total of annual deductibles and copayment/coinsurance amounts) before the plan begins to pay 100% for covered in-network services. This is different from an annual maximum because it includes all of the enrollee’s out-of-pocket costs, no matter how long it takes to reach the out-of-pocket maximum.
  3. 3Cost sharing refers to the enrollee’s annual out-of-pocket costs for health care. Each state determines what it considers to be a reasonable amount.

Questions?

Still have questions about finding or purchasing an ACA-compliant dental plan? Call our Marketplace and Exchange Plans Customer Service.

Call toll-free:
800-471-0236
Monday through Friday between 7:15 a.m. and 7:30 p.m., Eastern Time