Kentucky dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in Kentucky, premiums in May 2024 ranged from about $7 to $33 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 dental plans available in Kentucky will comply with the ACA’s pediatric dental coverage rules.

So out-of-pocket costs for pediatric dental care on a stand-alone plan 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. (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 major medical plan or sold as a stand-alone plan via the Marketplace — are guided by the state’s essential health benefits benchmark plan.

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

In 2024, there are two insurers who offer stand-alone individual/family dental coverage through the health insurance marketplace in Kentucky. Some health plans include both adult and pediatric coverage, some cover only one group, and other plans offer coverage to neither.

These are dental plans that are not included with a medical plan and must be purchased separately.

These plans can be purchased through Kynect 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 Kentucky. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Kentucky Department of Insurance.

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 and children enrolled in Medicaid in Kentucky are eligible to receive limited dental services such as exams, x-rays, emergency visits, extractions and fillings.

KCHIP, which is Kentucky’s CHIP, provides dental coverage to children up to age 19 living with families who have income above the eligibility limits for Medicaid.

• Kentucky Dental Association
• Kentucky free or low cost dental clinics
• Kentucky Medicaid
• Kynect