Dental insurance can cover the cost of preventive oral health services and help with the cost of more extensive procedures.
Even with insurance coverage, dental benefits may be limited. Here's how the major insurers handle dental care:
- Private Insurance. Under a traditional dental benefit, preventive dental services are typically free, however there may be a yearly cap on expenses. Learn about dental benefits available in the health insurance marketplace.
- Medicaid and FAMIS. Virginia Medicaid and FAMIS (Family Access to Medical Insurance Security) programs operate together to provide children and pregnant women with a comprehensive dental benefit through Virginia's Smiles for Children program. For other Medicaid-eligible adults, such as those who are aged, blind or disabled, Medicaid only covers emergency dental extractions, with the exception of those who are dually-eligible and enrolled in a Medicare-Medicaid Plan (MMP) that may offer some dental benefits.
- Medicare. No dental benefits, with the exception of those who are dually-eligible and enrolled in an MMP that may offer some dental benefits.
To find out if you're eligible for Medicaid, FAMIS or the health insurance marketplace, visit Cover Virginia.
Pediatric Dental Benefit
Pediatric dental coverage is considered one of the ten essential health benefits to be included in a Qualified Health Plan. In Virginia, pediatric dental benefits will be offered two different ways in the health insurance marketplace (or "exchange"):
- as an embedded benefit included in a health plan, or
- as a stand-alone plan (separate from health insurance).
Consumers should evaluate plans carefully when purchasing pediatric dental coverage, whether embedded or stand-alone, based on individual needs and considering any deductibles or out-of-pocket spending. For example, some embedded plans have a combined medical and dental deductible -- which means it is possible that a consumer would need to reach $2,500 in health expenses before any dental coverage can be used. Moreover, tax subsides based on income (to offset the cost of purchasing coverage) do not apply to stand-alone plans. Stand-alone and health plans may choose to provide an adult or family benefit as well -- but not all do.
This dental coverage fact sheet offers more details about coverage options in the exchange (available in Spanish, too).
View frequently asked questions about oral health in the Affordable Care Act.