Is dental insurance considered health insurance?
Dental insurance is not considered qualifying health insurance under the Affordable Care Act because it does not meet the minimum essential coverage guidelines. So, if you are buying a health plan through the marketplace, you can either get dental insurance as part of your health plan or separately.
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Brad Larson
Licensed Insurance Agent
Brad Larson has been in the insurance industry for over 16 years. He specializes in helping clients navigate the claims process, with a particular emphasis on coverage analysis. He received his bachelor’s degree from the University of Utah in Political Science. He also holds an Associate in Claims (AIC) and Associate in General Insurance (AINS) designations, as well as a Utah Property and Casual...
Licensed Insurance Agent
UPDATED: Feb 22, 2024
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UPDATED: Feb 22, 2024
It’s all about you. We want to help you make the right coverage choices.
Advertiser Disclosure: We strive to help you make confident insurance decisions. Comparison shopping should be easy. We are not affiliated with any one insurance provider and cannot guarantee quotes from any single provider.
Our insurance industry partnerships don’t influence our content. Our opinions are our own. To compare quotes from many different insurance providers please enter your ZIP code above to use the free quote tool. The more quotes you compare, the more chances to save.
On This Page
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- 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.
What is qualifying coverage?
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.
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What happens if I only have dental insurance?
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.
Read more: Top Dental Insurance Coverage: What You Need to Know
Will my children have dental coverage under my health plan?
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.
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How do I cancel my dental plan?
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 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.
Case Studies: Dental Insurance vs. Health Insurance
Case Study 1: Comprehensive Coverage
John, a 35-year-old, has newly enrolled in health insurance with comprehensive medical coverage, encompassing treatments, hospitalization, surgeries, and prescriptions. However, his dental insurance has limited coverage, restricted to routine check-ups and cleanings. John questions whether his dental insurance falls under his overall health insurance.
Case Study 2: Standalone Dental Insurance
Sarah is a 28-year-old woman who purchases a standalone dental insurance plan. This plan specifically covers a range of dental procedures, including preventive care, fillings, extractions, and orthodontics. Sarah wonders if her dental insurance can be regarded as a separate form of health insurance, or if it is distinct from traditional health coverage.
Case Study 3: Employer-Sponsored Benefits
Michael is a 45-year-old employee who receives health insurance benefits through his employer. His employer’s plan offers comprehensive health coverage, including medical, dental, and vision benefits. Michael questions whether the dental insurance component of his employer-sponsored plan is considered part of his overall health insurance package.
Case Study 4: Government-Sponsored Programs
Emily is a single mother who qualifies for government assistance in the form of Medicaid. She and her children are covered by Medicaid, which provides them with healthcare benefits, including medical and dental care. Emily wonders if the dental coverage provided by Medicaid falls under the umbrella of health insurance or if it is treated separately.
Case Study 5: Insurance Terminology
Alex is a 50-year-old individual who is exploring different insurance options. While researching plans, he comes across various terms like health insurance, dental insurance, and medical insurance. He is curious about the distinctions between these terms and how dental insurance fits into the broader context of health insurance.
Frequently Asked Questions
Is dental insurance considered health insurance?
While dental insurance is related to healthcare, it is typically considered a separate category from general health insurance. Dental insurance specifically focuses on covering costs related to dental care, including preventive, diagnostic, and treatment services for oral health issues.
How does dental insurance differ from general health insurance?
Dental insurance focuses exclusively on covering dental care expenses, while general health insurance provides coverage for a broader range of medical services, including hospitalization, doctor visits, prescription medications, and surgeries.
Can dental insurance be purchased as a standalone policy, separate from health insurance?
Yes, dental insurance can be purchased as a standalone policy, separate from general health insurance. Many employers offer dental insurance as a voluntary benefit, and individuals can also purchase individual dental insurance plans.
Are dental benefits included in all health insurance plans?
No, dental benefits are not automatically included in all health insurance plans. Some comprehensive health insurance plans may offer limited dental benefits, but it is more common for dental insurance to be a separate policy with its own coverage and premiums.
Do all dental insurance plans have waiting periods?
Waiting periods vary among dental insurance plans. Some plans may have waiting periods for specific services or treatments, especially for more extensive procedures. It’s important to review the policy terms to understand any waiting periods that may apply.
Are orthodontic treatments covered by dental insurance?
Orthodontic treatments, such as braces or aligners, may be covered by dental insurance, but coverage varies depending on the plan. Some plans provide limited coverage for orthodontics, while others may have separate orthodontic coverage or require additional riders or higher premiums.
Can dental insurance cover cosmetic procedures like teeth whitening or veneers?
Dental insurance primarily focuses on necessary dental treatments rather than cosmetic procedures. Cosmetic procedures like teeth whitening or veneers are often considered elective and may not be covered by dental insurance.
Is dental insurance necessary if I have good oral health?
Even with good oral health, dental insurance can provide financial protection and access to preventive services that help maintain oral health. It can also offer coverage for unexpected dental issues or emergencies that may arise.
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Brad Larson
Licensed Insurance Agent
Brad Larson has been in the insurance industry for over 16 years. He specializes in helping clients navigate the claims process, with a particular emphasis on coverage analysis. He received his bachelor’s degree from the University of Utah in Political Science. He also holds an Associate in Claims (AIC) and Associate in General Insurance (AINS) designations, as well as a Utah Property and Casual...
Licensed Insurance Agent
Editorial Guidelines: We are a free online resource for anyone interested in learning more about auto insurance. Our goal is to be an objective, third-party resource for everything auto insurance related. We update our site regularly, and all content is reviewed by auto insurance experts.