Health Care Reform: 5 Things to Know About Buying Dental Insurance

Posted on October 15, 2013 in Dental benefit information

Illinois residents are now able to purchase dental insurance through the Illinois Health Insurance Marketplace – “Get Covered Illinois”. The Marketplace opened on Oct 1, 2013 and will run through March 31, 2014.

“Better access to dental coverage is an important step toward improving the oral health of Illinois residents, particularly children” said Bernard Glossy, president and CEO of Delta Dental of Illinois. “The Illinois Health Insurance Marketplace – will provide another option for Illinois families to get the oral health coverage that gives them access to important dental care.”

The Illinois Health Insurance Marketplace is particularly important for Illinois residents who do not have coverage either through their employers or on their own, or who aren't covered by Medicaid. The new health care law requires that most U.S. citizens and legal residents have health insurance or pay a penalty. People are not required to purchase health and dental insurance through the exchange, but may qualify for federal tax subsidies to lower their premiums if they do. Depending on when members enroll, coverage could begin as early as 1/1/14.

Here are the important facts you need to know!

1. All plans must offer the same dental benefits for children.
Starting in 2014, all health plans sold to individuals must offer 10 essential health benefits (EHBs), one of which is pediatric dental care, including:

  • • Coverage for diagnostic and preventive care, as well as medically necessary orthodontia;
    • Coverage under age 19;
    • No annual or lifetime benefit maximum for covered services; and
    • Out-of-pocket limit of $700 per child or $1,400 per family.

2. Not all medical plans pay children's benefits equally and you don't have to purchase the required pediatric dental care from a medical carrier.
It is possible to purchase the pediatric dental benefit through a medical carrier or a stand-alone dental plan through a dental benefits carrier. Because many medical plans may require the policy's annual deductible and out-of-pocket maximums be met before paying dental benefits, a stand-alone dental policy may expand benefits and reduce overall expenses.

3. Different dental plan types are available.
All health care and dental plans must be differentiated in a way that helps consumers compare plans from different carriers. Dental plans are characterized as either High or Low.
All dental plans will meet the pediatric dental care requirement mandated.

4. Adult dental coverage is also an option.
Medical plans are not required to offer any dental benefits for adults, but they can be purchased through a stand-alone dental carrier.

5. Evaluate carrier differences.
Even though the coverage may be similar among different companies offering insurance, there are still differences consumers should consider. Some questions to ask include:

  • • Is your dentist part of the network offered by the carrier? This is important because not only will you enjoy the convenience of keeping your dentist, you may save money since network dentists have agreed negotiated fees which are lower than their usual fees.
    • Customer service is another key area. Consumers should look at service statistics, such as how quickly calls are answered and issues are resolved.

Delta Dental of Illinois is a Qualified Health Plan issuer in the Illinois Health Insurance Marketplace.