Maryland dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in Maryland, premiums in May 2024 ranged from about $8 to $52 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.

Stand-alone dental plans sold via Maryland Health Connection (the state-run Marketplace) must comply with the ACA’s rules for children’s dental coverage.

So out-of-pocket costs for pediatric dental care on a stand-alone plan sold via Maryland Health Connection will not exceed $400 per child in 2024 (or $800 for all the children on a family’s plan),² and they don’t have a 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.

Maryland Health Connection notes that all of its available medical plans included embedded pediatric dental benefits. But stand-alone dental plans can be purchased for children who do not have health coverage through Maryland Health Connection.⁴

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 Maryland’s benchmark plan, which does include coverage for both basic and major dental services for children.

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

These plans can be purchased through the Maryland exchange 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 Maryland off the exchange. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Maryland Insurance Administration. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.

In Maryland, there are also various dental discount plans available. Dental discount plans are not dental insurance, but can offer lower prices for services 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.

Starting in 2023 (due to legislation enacted in 2022), Maryland permanently expanded dental services for adult Medicaid recipients. Adults now have access to diagnostic, preventive, periodontal, and restorative services with no cap or annual benefit maximum. Children can receive dental services through Medicaid and the state’s Healthy Smiles program.

MCHP, which is Maryland’s CHIP, provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

• Maryland Dental Association
• Maryland free or low cost dental clinics
• Mission of Mercy
• Maryland Medicaid (Healthy Smiles)
• Maryland Health Connection