Considerations for Selecting a Stand-Alone Dental Plan

by | Jun 23, 2014 | Affordable Care Act, Oral Health, Patient Protection and Affordable Care Act | 0 comments

Effective January 1, 2014, the Affordable Care Act (ACA) requires children to have dental coverage. (Major exceptions to this rule exist, including for those getting their health insurance through their employer.) Since pediatric dental coverage is now an “Essential Health Benefit”, stand-alone dental plans (SADPs) are a popular alternative option for individuals who want to purchase dental insurance apart from their medical insurance. That is actually the “norm” today; the National Association of Dental Plans reports that 98 percent of people in the United States with dental insurance have a SADP apart from their medical coverage.

SADPs are available on the Health Insurance Marketplace (HIM) in Maine and New Hampshire and on Vermont Health Connect (VHC) in Vermont. Thus far, 4,500 consumers in Maine, New Hampshire and Vermont have signed up for SADPs on the HIM and on VHC. SADPs are also available online directly from dental carriers and in the private marketplace. Northeast Delta Dental provides dental insurance coverage through all of these options.

On the HIM or VHC if a medical insurer is offering dental coverage, individuals can select to either purchase a combined medical/dental package from their medical insurer or purchase their medical coverage from the medical insurer and enroll separately in a SADP for their dental coverage.

There are multiple factors to consider before purchasing a combined medical and dental package. First of all, a combined medical and dental package typically applies the medical deductible to both the medical and dental claims, in which case the medical deductible must be satisfied before any dental claims are paid. Additionally, renewal prices for the combined package are based on the medical plan. And, if the plan is purchased on the HIM, the renewal price for the combined package will also include a 3.5 percent fee. Since dental insurance plans have very different loads for industry factors than medical insurance plans do, the medical rating restrictions will also be different with combined plans. Possibly the biggest difference to consider is that the 2014 medical out-of-pocket maximum, which generally is applicable to dental claims in a combined medical and dental package, is more than nine times (9x) the 2014 SADB out-of-pocket maximum, $6,350 vs $700. Once an out-of-pocket maximum is satisfied, all covered services are covered at 100%; until then, the consumer is paying some or all of the costs.

An advantage of a combined plan is a single contract bill for the medical and dental coverage. However, in addition to the points above, with a combined plan there may be fewer choices for dental providers, or there may be a requirement to switch your dentist based on the plan.

Always consult with your health insurance professional to determine which plan is best for your employees and/or family.

To enroll in a Northeast Delta Dental plan, please visit, call your insurance agent, or contact us directly at 1-800-537-1715. And as always, you can find us at

Tom Raffio
June 2014

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