A Basic Explanation

The Affordable Care Act (ACA) says that all children under age 19 are entitled to basic dental care. In fact, pediatric dental insurance is one of the ACA’s 10 essential benefits that must be included in all marketplaces plans.

Children should see their dentist regularly to make sure their teeth and gums stay healthy. Pediatric dental insurance helps pay the cost.

Most plans cover preventive services like cleanings and X-rays. Many also cover fillings and other types of dental care when kids see an in-network dentist. Some plans may have annual deductibles plus copays and coinsurance; others might not.

Expert Advice About Dental Insurance for Kids

You can buy pediatric dental insurance in one of two ways: separately or as part of a medical insurance plan.

Many insurance companies include pediatric dental coverage as part of their medical plans, while others offer stand-alone policies. It pays to shop around to get the benefits you want at the best price.

You may be able to use some of your tax credits to buy a stand-alone dental plan.

If you have any leftover tax credits after paying for your medical insurance, you can use them to buy a separate dental plan as long as children’s care is included in the plan and your medical insurance doesn’t already include children’s dental benefits.

If you buy a separate dental plan, the ACA limits what you’ll have to pay out of pocket for in-network dental care.

Cost-sharing and deductibles vary among plans, but any federal marketplace plan you buy will cap your out-of-pocket costs for pediatric dental (meaning the most you’ll pay) at $700 per child ($1,400 per family) per year. State marketplaces may differ, but in general they limit out-of-pocket costs to no more than $1,000. (If dental coverage is part of your medical plan, you may have to meet your full medical deductible before your insurance company starts sharing the costs.)

What Else You Need to Know:

  • Pediatric dental plans may not cover everything. Most plans will cover two preventive cleanings per year, fluoride treatments, basic services such as fillings, tooth extractions, and root removal. However, they’ll usually pick up only part of the cost for major dental work such as braces and other orthodontics, root canals, and periodontics (for the gums).
  • Some benefits require a waiting period before you can use them. Although most preventive services will be free of charge and available right away, your child may have to wait six months or more before he or she can use some of the other benefits. And you’ll usually need to meet the out-of-pocket deductible before the insurance carrier will share any of the costs (other than the preventive ones) with you.
  • You’re not required to buy dental insurance for your kids . . . but why wouldn’t you? Although the ACA says that all marketplaces must offer dental benefits for kids, you’re under no obligation to buy it, and there’s no penalty for not having it. But why wouldn’t you want to protect your kids’ teeth? Chronic tooth decay is one of the most common health problems for American children. By ensuring all kids can get the affordable care they need to keep their teeth and gums healthy, the law sets them up for a lifetime of better health overall.