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.