Dental Coverage on Exchanges

The Dental Coverage on Exchanges was recently addressed in New York Times article Dental Coverage on the Insurance Exchanges. The paper pays particular attention to Exchange Dental Coverage for Medicare beneficiaries. Here is the brief synopsis of the article.

How Dental Coverage on Exchanges is different from the Health Coverage?

There are a surprising number of differences. Dental plans seem to be much less constrained in the number of required benefits and protection rules than the health plans. For example,

  • Standalone dental plans can set annual dollar limits on coverage plans
  • Standalone dental plans don’t have to comply with caps on out-of-pocket spending, as health plans.
  • Insurance premium tax credits and cost-sharing reductions are not available
  • In some states, the preexisting conditions still exist for dental plans

Dental Coverage on Exchanges for Medicare Beneficiaries

Medicare beneficiaries are legally entitled to buy standalone dental plans on exchanges. (The vast majority of people having Medicare plans does not have ANY needs to buy a health plan on Exchanges, just a standalone dental plan). But their options to buy dental coverage depend on the state where they live. In particular:

  • In states where the Federal Government is running the exchanges, dental coverage is available ONLY to those who is buying health coverage. Therefore, standalone dental coverage for Medicare beneficiaries in those states is actually unavailable.
  • In some state-run Exchanges, like Maryland, Medicare beneficiaries may actually buy the standalone dental coverage. In other states dental policies are wrapped into health plans and are not available standalone.

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