2025 Pennsylvania Dental Plans
Here are the plans available through the Health Insurance Marketplace in your state
Pennsylvania Dental Plan Comparison
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| PREMIER PPO HIGH | PREMIER PPO LOW | ADVANTAGE PPO | ADVANTAGE PPO LOW | ADVANTAGE COPAY | ||||||
| Premier Network | Out of Network | Premier Network | Out of Network | Advantage Plus 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% | 100% up to MAC* | 100% | See CoPay Schedule |
| Basic | 80% | 80% up to MAC* | 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% up to MAC* | 50% | 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) |
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Orthodontics (Up to age 19**) (Medically Necessary)
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50% | 50% | 50% | 50% | 50% | 50% | 50% / Discount Only (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 (Up to age 19**) (Non-Medically Necessary)
|
50% | 50% | Discount Only | Not Covered | Discount Only | Not Covered | Discount Only (Children up to age 19** / Adults age 19 and older) |
Not Covered (Children up to age 19** / Adults age 19 and older) |
Discount Only / Not Covered | |
| Waiting Periods | ||||||||||
| Preventive | None | 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 / Non-Medically Necessary)
|
None / 24 Month Waiting Period | None / Not Applicable | None / Not Applicable | None / Not Applicable | None / Not Applicable | |||||
| Deductible | ||||||||||
| Individual | $100 | $100 | $100 | $50 | $50 | |||||
| Family Max | $300 | $300 | $300 | $150 | $150 | |||||
| Maximums | ||||||||||
| Major Annual Max (age 19 and older) | $750 | $500 | $500 | No Maximum | No Maximum | |||||
| Annual Max per Person (age 19 and older) | $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 / Not Applicable (Children up to age 19** / Adults age 19 and older) |
No Maximum | |||||
| Pediatric Individual EHB Out-of-Pocket Max (up to age 19**) |
$425 | $425 | $425 | $425 | $425 | |||||
| Pediatric Family EHB Out-of-Pocket Max (up to age 19**) |
$850 | $850 | $850 | $850 | $850 | |||||
| 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