Dental coverage in the Health Insurance Marketplace

There are two ways to get dental coverage through the Marketplace.

Michigan State University Extension explains that there are two ways to get dental coverage through the Health Insurance Marketplace. One way is to purchase a health plan that includes dental coverage. The other is to purchase dental coverage separately.

There are differences between dental coverage that is sold as part of a health plan and dental plans that are sold separately. One difference is the amount you will pay out-of-pocket (for co-pays and deductibles). This is referred to as the “out of pocket limit.” Health coverage has an out of pocket limit, meaning there is a cap on the amount that you will spend for health care (not including the premium). Once that limit is reached, the plan picks up all of the rest of your covered care for that plan year.

If dental care is included in a health plan, then the out of pocket costs for dental care count toward the out of pocket limit. If dental care is purchased separately, then that policy will have its own out of pocket limit. Out of pocket limits for dental plans are usually smaller than those for health plans.

Another difference between dental plans and health plans is the protections for the consumer, or purchaser of the plan, through the Affordable Care Act (ACA). Not all of the act’s protections apply to dental coverage. It will depend on the laws of the state in which you live in and on the dental plan you choose. One way to find out which consumer protections are provided within a particular plan may be to ask a dental plan representative. It would be a good idea to get the representative’s information in writing when you do.

There is financial assistance available to help pay for monthly premiums in the Health Insurance Marketplace. The amount of assistance will depend on your household income and family size. If you qualify for assistance, you may apply it toward a health plan that includes dental coverage. You may also choose to purchase a plan that doesn’t include dental coverage, and then apply any assistance you have left toward the purchase of a separate dental plan. If you are just buying a dental plan alone, you cannot get financial assistance to help pay for it.

MSU Extension offers consumer education about making healthcare choices in the Health Insurance Marketplace. Through Smart Choice Health Insurance participants will determine what they want from health care providers, compare healthcare plans, determine the cost of the plans and will apply what they learn to make the right choice in healthcare plans for them. For more information, visit

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