How does dental coverage in the Federal Marketplace work?


If there’s one thing everyone knows about looking for health and dental insurance, it’s that it can be confusing and hard to navigate. The whole process can be a little stressful whether you’re searching through private health insurance companies or the Federal Marketplace. Fortunately for you, this article is going to help you understand the difference between health and dental insurance and how they work together (or separately) in the Federal Marketplace.

In the Health Insurance Marketplace, you can get federal marketplace dental insurance as part of a health plan or through a separate, stand-alone plan. If you want it to be included in your affordable health insurance plan, then you will pay one monthly premium that includes both the health and dental coverage.

If you want a stand-alone dental plan that’s completely separate from your health plan, you will have two different monthly premiums you need to pay. Also be aware that you can’t buy a Marketplace dental plan unless you’re buying a health plan at the same time.

Marketplace dental plans (whether they’re individual dental insurance plans or group dental insurance plans) have two categories—high and low. High coverage plans have higher premiums but lower copayments and deductibles. Low coverage plans have lower premiums but higher copayments and deductibles. It’s important to compare dental plans when shopping in the Marketplace because each plan has different costs, copayments, deductibles, and benefits.

What Else Do I Need to Know When Shopping for Dental Coverage in the Marketplace?

There are a few other important details you need to know when looking for the best affordable dental insurance in the Federal Marketplace. For instance, if you’re already enrolled in a Marketplace insurance plan, you can’t simply add on dental coverage. You have to wait until the next Open Enrollment Period to change to a plan that includes dental coverage or to add a stand-alone dental plan.

It’s important to be aware that dental coverage is an essential health benefit for children 18 or younger. So what does that mean? It means dental coverage must be available for them as part of a health plan or as a separate plan. However, while children must have some sort of dental coverage, adults are not required to buy it.

If you want to cancel your Marketplace dental coverage but still keep your health coverage, it’s a little bit tricky. With a stand-alone dental plan, you can cancel your dental plan at any time by not making payments. This won’t affect your health plan at all because they’re completely separate. As long as you keep paying for your health plan, you’ll stay enrolled in it.

If you have a health plan that has dental benefits, the only way to get out of the dental coverage is to wait until Open Enrollment and get a health plan without dental benefits. Unless you qualify for a Special Enrollment Period, waiting until Open Enrollment is the only way to get a stand-alone health or dental plan.

How Do You Use Your Marketplace Dental Insurance Once You’re Signed Up?

After picking out the right dental plan and getting your insurance card in the mail, you’re set to go, right? Not quite. There are a few things you need to do before you stroll into any dentist’s office. Here is a quick list you can follow if you don’t know what those things are:

1.   Make sure you know your out-of-pocket costs.

·         With a high coverage plan, you’ll pay more per month but you will have lower copays and deductibles.

·         With a low coverage plan, you have to pay more when you get to the dentist and use his services, but you’ll pay less each month.

2.    Find a dentist that accepts your specific dental plan.

·         If you go to a dentist that’s out-of-network (even unknowingly) you’ll always end up paying more, even for basic preventive care that’s usually 100 percent covered by most plans.

·         How do you know if a dentist is in-network? You can search for providers online through your account, you can call your insurance company, or you can call the dentist office you want to go to.

·         Always have your insurance card handy so that the receptionist has all the information she needs to put you into the system as a patient.

3.     Know what benefits your dental plan includes.

·         While most dental plans cover basic preventive care like cleanings every six months, it’s good to check just to make sure.

·         You’ll want to know if fillings are covered if you have a cavity.

·         Some dental plans only cover children while others cover entire families—that’s why it’s smart to find out exactly what’s covered before you set up an appointment.


Contact EMI Health today if you want to learn more about our Federal Marketplace dental insurance.

EMI Health offers Federal Marketplace dental insurance suited to your needs. These plans are not only affordable, but they also cover the basic but important care. In addition to Federal Marketplace plans, we also provide senior dental plans and a wide variety of health plans. Whatever your need may be regarding insurance, we’ve got you covered. Contact us today by calling 1-800-662-5851 or by visiting