Federal Marketplace/Exchange

2021 Pennsylvania Dental Plans

Here are the plans available through the Health Insurance Marketplace in your state

Looking for 2022 Plans?

Pennsylvania Dental Plan Comparison

We have several dental options for you and your family.
If you see a plan you like, you can then head to the Marketplace to enroll.
VISIT HEALTHCARE.GOV VIEW AS PDF

For plan year 2021, Pennsylvania is transitioning from HealthCare.gov to its own state-based health insurance marketplace, Pennie. Pennie will be live at the beginning of the 2021 Open Enrollment Period, which runs from November 1, 2020, through January 15, 2021. Please visit pennie.com to find information and assistance on your health insurance options moving forward.

CHOICE PPO HIGH CHOICE PPO LOW ADVANTAGE PPO ADVANTAGE PPO LOW ADVANTAGE COPAY
Advantage Network Premier Network Out of Network Advantage Network Premier Network Out of Network Advantage Network Out of Network Advantage Network Out of Network Advantage Network Out of Network
Services
Preventive 100% 100% 100% up to MAC* 100% 100% 80% up to MAC* 100% 100% up to MAC* 100% 100% up to MAC* 100% See CoPay Schedule
Basic 80% 80% 80% up to MAC* 60% 60% 50% up to MAC* 50% 50% up to MAC* 50% / Not Covered
(Children up to age 19** / Adults age 19 and older)
 50% up to MAC* / Not Covered
(Children up to age 19** / Adults age 19 and older)
 See CoPay Schedule
Major 50% 50% 50% up to MAC* 50% 40% 30% up to MAC* 25% 25% up to MAC* 25% / Not Covered
(Children up to age 19** / Adults age 19 and older)
 25% up to MAC* / Not Covered
(Children up to age 19** / Adults age 19 and older)
Orthodontics
(Medically Necessary)
 50% 50% 50% 50% 50% 50% 50% 50% 50% / Not Covered
(Children up to age 19** / Adults age 19 and older)
 50% / Not Covered
(Children up to age 19** / Adults age 19 and older)
 50% 50%
Orthodontics
(Non-Medically Necessary)
 50% 50% 50% Discount Only (Up to 25%) Discount Only (Up to 25%) Not Covered Discount Only (Up to 25%) Not Covered Discount Only Not Covered Discount Only (Up to 25%) Not Covered
Waiting Periods
Preventive None None None None
Basic None None None None None
Major 15 Month Waiting Period 18 Month Waiting Period 12 Month Waiting Period None 12 Month Waiting Period
Orthodontics
(Medically Necessary)
 None None None None None
Orthodontics
(Non-Medically Necessary)
 24 Month Waiting Period Not Applicable Not Applicable Not Applicable Not Applicable
Deductible
Individual $100 $100 $100 $50 $50
Family Max $300 $300 $300 $150 $150
Deductible Applies To Basic and Major Preventive, Basic and Major Preventive, Basic and Major Preventive, Basic and Major Preventive, Basic and Major
Maximums
Major Annual Max $750 $500 $500 No Maximum No Maximum
Annual Max per Person $1,500 $1,000 $1,500 $1,000 $1,000 No Maximum No Maximum
Orthodontic Lifetime Max
(Medically Necessary / Non-Medically Necessary)
 No Maximum / $1,000 No Maximum / Not Applicable No Maximum / Not Applicable No Maximum / Not Applicable No Maximum / Not Applicable
Pediatric EHB Annual Max No Maximum No Maximum No Maximum No Maximum No Maximum
Pediatric Individual EHB Out-of-Pocket Max $350 $350 $350 $350 $350
Pediatric Family EHB Out-of-Pocket Max $700 $700 $700 $700 $700
View Plan Details See 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 Health Plans Life, Accident & Health, Inc.

**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 Pennsylvania Insurance Department. They meet all Federal regulations, fulfilling the requirements of the Affordable Care Act for individuals. General Policy Provisions