Michigan dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in Michigan, premiums in May 2024 ranged from about $7 to $43 per month.¹

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 exchange-certified pediatric stand-alone dental plans available in Michigan via HealthCare.gov will comply with the ACA’s pediatric dental coverage rules.

This means the out-of-pocket costs for pediatric dental care on a stand-alone plan 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 Marketplace health 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 sold via the Marketplace as a stand-alone dental plan) are guided by the state’s essential health benefits benchmark plan.

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

In 2023, nine insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in Michigan. These are dental plans that are not included with a medical plan and must be purchased separately:

• BEST Life
• BCBS of Michigan
• DENCAP Dental Plans
• Delta Dental
• Dentatrust / DentaSpan
• EMI Healthcare
• Guardian
• Humana
• Paramount

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 Michigan. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Michigan Department of Insurance and Financial Services. 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 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 Michigan are eligible for dental services through the Healthy Michigan Plan. Children are also eligible for dental benefits through Michigan Medicaid.

MIChild, which is Michigan’s CHIP, provides dental coverage to uninsured children 19 years of age and under.

• Michigan Dental Association
• Smile Michigan – free or low cost dental clinics
• Michigan Medicaid (MI Bridges)
• HealthCare.gov