Dental insurance and coverage of dental benefits are offered by Maryland Health Connection.
Children under the age of 21 (as well as pregnant women) who qualify for Medicaid have access to dental benefits year-round. Medicaid and Maryland Children’s Health Plan (MCHP) are required to provide dental benefits to children who are eligible. Covered benefits include exams, cleanings, fillings, and braces (if medically necessary). Some of the Maryland Managed Care Organizations offer limited dental coverage for adults 21 and older. Check HealthChoice MCO comparison chart.
As of 2017, embedded pediatric dental services are optional for carriers to include in qualified health plans offered on the Maryland Health Connection. However, in 2020, all qualified health plans include some embedded pediatric dental benefits.
If seeking adult dental coverage on Maryland’s exchange, the consumer can access dental benefits in three ways, 1) enroll in a dental-only plan (stand-alone dental plan) during open enrollment, 2) enroll in a health plan which includes dental benefits for adults, or, 3) enroll in a health plan and a stand-alone dental plan on the exchange.
As outlined above, consumers can purchase a stand-alone dental plan from Maryland Health Connection even if they do not need health insurance. If a consumer is only applying for dental benefits on MHC, they will not need to provide income and tax information because federal tax credits (APTC) are not offered for stand-alone dental plans. If the consumer does choose a stand-alone dental plan in addition to their health plan, they will pay a separate, additional premium to the dental carrier.
Stand-alone dental plans on the Maryland Health Connection are only offered during Open Enrollment (November 1 – December 15 for coverage the following year). There are certain circumstances or qualifying events which allow an opportunity to enroll in a dental plan outside of open enrollment.
A move into the State is a qualifying life event that triggers a Special Enrollment Period for dental coverage. New residents have 60 days before or after moving into the State to enroll in a dental plan. Also, marriage, birth of a newborn, or adoption will allow an enrolled family to add dental coverage outside of open enrollment.
There are several dental carriers that offer stand-alone dental plans on Maryland Health Connection:
DeltaCare USA/ Alpha Dental
CareFirst Blue Cross Blue Shield also offers stand-alone dental plans.
The dental plans are offered in two tiers: high and low
The high coverage level has higher premiums but lower copayments and deductibles. The consumer will pay more every month, but less when they use dental services.
The low coverage level has lower premiums but higher copayments and deductibles. The consumer will pay less every month, but more when they use dental services.
Dental plans are also offered by network type: HMO and PPO. The HMO plans restrict coverage to in-network dental providers. The PPO plans cover a smaller percentage for services provided outside of the provider network.
The ACA requires dental plans to have an annual out of pocket maximum for pediatric services only. This is the maximum amount a consumer will have to pay for pediatric dental services during each plan year. The maximum out-of-pocket on stand-alone pediatric dental plans is $350 for a single child, and $700 per family if more than one child is covered on the plan. This is a common scenario on plans with embedded pediatric dental, although preventive pediatric dental care is sometimes covered before the deductible is met. Important note: Adult dental benefits are not protected by the out-of-pocket maximum established by the ACA.
Enrollees in a stand-alone dental plan can cancel at any time. Non-payment of a stand-alone dental premium will eventually result in termination of the policy.