District of Columbia dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in DC, premiums in May 2024 ranged from about $9 to $49 per month.¹

If a family is purchasing coverage through DC Health Link, the premiums attached with pediatric dental coverage may or may not be canceled out by premium tax credits (premium subsidies). Here’s more about how that works, depending on whether the policy has integrated pediatric dental benefits.

The pediatric stand-alone dental plans available in the District of Columbia will comply with the ACA’s pediatric dental coverage rules. This means out-of-pocket costs for pediatric dental care will not exceed $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.

As with all essential health benefits, the specific coverage requirements for pediatric dental care are guided by DC’s essential health benefits benchmark plan.

Click here to see details for the District of Columbia’s benchmark plan, which does include coverage for both basic and major dental services for children.

If a medical insurance policy offered via DC Health Link has embedded pediatric dental coverage, it must have a separate deductible for the pediatric dental benefits (ie, it cannot apply those benefits to the plan’s regular medical deductible). The maximum allowable deductible for embedded pediatric dental benefits in 2024 is $50 in-network or $100 out-of-network for a single child, and double those amounts for all the children on a family’s policy.³  Note that these rules do not apply to catastrophic plans or HDHPs, as that would run afoul of federal rules for those plans.

In 2024, there are four insurers who offer stand-alone individual/family dental coverage through the health insurance marketplace in the District of Columbia.⁴ These are dental plans that are not included with a medical plan and must be purchased separately.

These plans can be purchased through DC Health Link during open enrollment (November 1 to January 31) 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 the nation’s capital. These plans are not subject to the ACA’s essential health benefit rules for children’s dental coverage, but they are regulated by the DC Department of Insurance, Securities, and Banking. To purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.

In DC, there are also various dental discount plans available. Dental discount plans are not dental insurance, but can offer discounted rates at participating dentists. Here’s what you need to know to weigh the differences between dental insurance and dental discount plans.

To find dental discount plans in DC, search online for dental discount plans and the District of Columbia.

Adults and children enrolled in DC Medicaid are eligible for comprehensive dental benefits. Adult services are completed through a fee-for-service program.

DC Healthy Families, which is the District of Columbia’s CHIP, provides dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

• District of Columbia Dental Society
• District of Columbia free or low cost dental clinics
• DC Healthy Families (Medicaid)
• DC Health Link