2025 Idaho Dental Plans
Here are the plans available through the Health Insurance Marketplace in your state
Idaho Dental Plan Comparison
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| PREMIER PPO HIGH PLAN | PREMIER PPO LOW PLAN | ADVANTAGE PPO PLAN | ADVANTAGE COPAY PLAN | |||||
| Premier Network | Out of Network | Premier Network | Out of Network | Advantage Plus Network | Out of Network | Advantage Network | Out of Network | |
| Services | ||||||||
| Preventive | 100% | 100% up to MAC* | 100% | 80% up to MAC* | 100% | 100% up to MAC* | 100% | See Co-Pay Schedule |
| Basic | 80% | 80% up to MAC* | 60% | 50% up to MAC* | 50% | 50% up to MAC* | See Co-Pay Schedule | |
| Major | 50% | 50% up to MAC* | 40% | 30% up to MAC* | 25% | 25% up to MAC* | ||
|
Orthodontics (up to age 19**)
(Medically Necessary) |
50% | 50% | 50% | 50% | 50% | 50% | 50% | 50% |
|
Orthodontics (up to age 19**)
(Non-Medically Necessary) |
50% | 50% | Discount Only | Not Covered | Discount Only | Not Covered | Discount Only | Not Covered |
| Waiting Periods | ||||||||
| Preventive | None | None | None | None | ||||
| Basic | 6 Month Waiting Period | 6 Month Waiting Period | 6 Month Waiting Period | 6 Month Waiting Period | ||||
| Major | 15 Month Waiting Period | 18 Month Waiting Period | 12 Month Waiting Period | 12 Month Waiting Period | ||||
|
Orthodontics (Medically Necessary)
|
None | None | None | None | ||||
|
Orthodontics (Non-Medically Necessary)
|
24 Month Waiting Period | Not Applicable | Not Applicable | Not Applicable | ||||
| Deductible (applies to Preventive, Basic and Major) | ||||||||
| Individual | $25 | $100 | $100 | $50 | ||||
| Family Max | $75 | $300 | $300 | $150 | ||||
| Maximums | ||||||||
| Major Annual Max | $750 | $500 | $500 | No Maximum | ||||
| Annual Max per Person | $1,000 | $1,000 | $1,000 | No Maximum | ||||
| Orthodontic Lifetime Max (Medically Necessary) |
No Maximum | No Maximum | No Maximum | No Maximum | ||||
| Orthodontic Lifetime Max (Non-Medically Necessary) |
$1,000 | Not Applicable | Not Applicable | Not Applicable | ||||
| Pediatric EHB Annual Max | No Maximum | No Maximum | No Maximum | No Maximum | ||||
| Petriatric Individual EHB Out-of-Pocket Max | $425 | $425 | $425 | $425 | ||||
| Pediatric Family EHB Out-of-Pocket Max | $850 | $850 | $850 | $850 | ||||
| View Plan Details | See Plan Details | See Plan Details | See Plan Details | See Plan Details | ||||
Benefits illustrated are in summary only. Refer to your Dental Policy for a complete description of benefits, limitations and exclusions.
*All Services are subject to EMI Health Maximum Allowable Charge (MAC). When using a Non-participating Provider, the insured is responsible for all fees in excess of the Maximum Allowable Charge (MAC). Underwritten by Educators Mutual Insurance Association. EMI Association does not discriminate on the basis of basis of race, color, national origin, disability, age, sex, gender identity, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.
**Through the last day of the month in which the Insured turns 19 years of age
These EMI Health dental plans have been reviewed and approved by the Idaho Insurance Department. They meet all Federal regulations, fulfilling the requirements of the Affordable Care Act for individuals. General Policy Provisions