Wisconsin dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in Wisconsin, premiums in May 2024 ranged from about $9 to $52 per month.²

If a family is purchasing coverage through the health insurance exchange, 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 pediatric stand-alone dental plans available in Wisconsin’s health insurance Marketplace (exchange) have to comply with the ACA’s pediatric dental coverage rules.

This means the 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),³ 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.⁴)

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.

According to a Milliman analysis of 2024 coverage, some medical plans available through the Oklahoma exchange include embedded pediatric and adult dental coverage.¹ There are also stand-alone dental plans available.

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.

You can see details here for Wisconsin’s benchmark plan, which does include coverage for both basic and major dental services for children.

In 2024, there are seven insurers that offer stand-alone individual/family dental coverage through the health insurance marketplace in Wisconsin. These are dental plans that are not included with a medical plan and must be purchased separately.

These plans 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 Wisconsin. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Wisconsin Division 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. Here’s what you need to know about the differences between dental insurance and dental discount plans.

To locate these plans in your area, search online for dental discount plans and the state of Wisconsin.

Adults and children enrolled in Medicaid in Wisconsin are eligible for extensive dental services through BadgerCare+. The benefits do not cover orthodontia and some other procedures require prior approval.

BadgerCare+ also administers Wisconsin’s CHIP, and provides comprehensive dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

• Wisconsin Dental Association
• Wisconsin free or low cost dental clinics
• Wisconsin Medicaid
• HealthCare.gov