The Affordable Care Act requires most Americans to have health insurance or pay a penalty fee, but you might wonder whether health insurance extends to products like dental and vision coverage. Under the new law, major medical insurance includes coverage for things like preventive care, rehabilitative treatments, maternity services and pediatric care. With so many features included in today’s major medical plans, some people assume that dental and vision are also covered. However, the law does not require insurers to cover dental or vision care for adults. In fact, many insurers still don’t offer this type of protection with their medical packages.
Dental Care for Kids
While dental coverage is not mandated for adults, parents will be pleased to know that the Affordable Care Act does encourage dental protection for children. Insurers on the marketplace must offer dental coverage to children under the age of 18 because pediatric dental care is considered an essential benefit. The American Dental Association predicted in 2013 that about 8.7 million children will benefit from this requirement by 2018. Every year, millions of children and adults suffer needlessly from dental conditions that may be avoidable with routine cleanings and treatments. By requiring insurers to offer coverage, the government is working toward helping people prevent serious, life-threatening medical conditions.
Vision care is also an essential benefit for children, and insurance carriers will offer this coverage under the major medical policy that you buy for your kids. Vision care includes routine eye exams and glasses, but actual coverage amounts will vary depending on your policy.
It’s important to note that you do not have to buy dental or vision coverage for your kids even though the new law requires insurers to offer these policies. They will be available to anyone who purchases a major medical plan, but that doesn’t mean that you’ll be required to buy them. Under the new law, you have to buy major medical plans in order to avoid the penalty fee, but dental and vision plans don’t count toward minimum essential coverage. It’s totally up to you to purchase these optional policies.
Where to Buy Dental and Vision Plans
In addition to buying dental and vision plans through independent agencies or signing up for a plan through your employer, you now have the option to buy dental and vision coverage through federal or state marketplaces. The ACA made it easier for people to sign up for major medical plans, and you can use the health insurance exchange sites to purchase vision and dental plans with some restrictions. You have two choices for buying dental coverage on HealthCare.gov:
- You can enroll in dental coverage as part of a major medical plan that offers it when you sign up for a policy during open enrollment.
- You can sign up for a standalone dental plan once you enroll in a separate major medical plan during open enrollment.
Keep in mind that you can only sign up for dental insurance on the marketplace during open enrollment and only if you first buy a major medical policy. Some plans include dental coverage already, so read the terms carefully to see if your selected plan offers dental coverage. Children’s plans also might be included or might be sold as standalone plans.
You can’t buy a standalone vision plan for yourself on the marketplace. Only children’s vision plans are included with major medical policies, and not all policies include this coverage. If you need vision insurance or want more comprehensive coverage, then you’ll need to check out private or employer-based options. Note that dental and vision coverage do not qualify for subsidies on the marketplace.