North Carolina uses the federally facilitated health insurance Marketplace HealthCare.gov for the sale of certified individual/family dental plans.
Not all insurers that offer medical plans through the North Carolina exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children.
For adults who purchase their own stand-alone dental coverage through the exchange in North Carolina, premiums in May 2024 ranged from about $8 to $46 per month. 1
If a family is purchasing coverage through the North Carolina marketplace, the premiums associated with pediatric dental coverage may or may not be offset by premium tax credits (premium subsidies). Here’s more about how that works, depending on whether the health plan has integrated pediatric dental benefits.
The stand-alone pediatric dental plans available in North Carolina’s Marketplace (HealthCare.gov) will comply with the ACA’s pediatric dental coverage rules.
So out-of-pocket costs for pediatric dental care on a stand-alone dental plan purchased via HealthCare.gov won’t be more than $400 per child in 2024 (or $800 for all the children on a family’s plan), 2 and there is no cap on medically necessary pediatric dental benefits. (For 2025, the out-of-pocket maximums will increase to $425 and $850, respectively. 3 )
If a medical plan has embedded pediatric dental benefits, the maximum out-of-pocket limits described above are not applicable. However, there will be no limit on how much the plan will pay for pediatric dental care, since it’s an essential health benefit.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care (either embedded in an ACA-compliant individual market plan, or obtained via HealthCare.gov as a stand-alone dental plan) are guided by the state’s essential health benefits benchmark plan.
The North Carolina benchmark plan includes coverage for both basic and major dental services for children.
In 2024, seven insurers offers stand-alone individual/family dental coverage through the health insurance marketplace in North Carolina. These are dental plans that are not included with a medical plan and must be purchased separately.
This coverage can be purchased through HealthCare.gov during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event. Exchange-certified stand-alone dental plans are compliant with the ACA’s rules for pediatric dental coverage.
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in North Carolina. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the North Carolina Department of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
There are also various dental discount plans available in every state. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Learn about the differences between dental insurance and dental discount plans.
To find plans in your area, search online for dental discount plans and the state you are looking to buy a plan in.
Adults enrolled in Medicaid in North Carolina are eligible for extensive dental services with no annual spending limits. Children are eligible to receive extensive dental benefits either through Medicaid or Health Choice, the state’s Medicaid managed care program.
North Carolina Health Choice for Children (NCHC), which is North Carolina’s CHIP, provides dental coverage to uninsured children ages six through 18 who are not enrolled in Medicaid.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
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