Montana dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in Montana, premiums in May 2024 ranged from about $16 to $55 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.

Embedded dental coverage is not included in any of the health plans available in Montana via HealthCare.gov,¹ so stand-alone dental plans are the only way for Marketplace enrollees to obtain dental coverage.  The stand-alone dental plans available in Montana’s Marketplace (HealthCare.gov) will comply with the ACA’s pediatric dental coverage rules.

So 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)

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.

The Montana benchmark plan includes coverage for both basic and major dental services for children.

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

This coverage 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 Montana. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Montana Insurance Department. 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. Learn 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 Montana are eligible for extensive dental services up to an annual limit of $1,125 (anesthesia, dentures, diagnostic and preventative services do not count towards the annual cap). Children eligible for Medicaid also receive extensive dental benefits including bridges, crowns and dentures.

Healthy Montana Kids (HMK), which is Montana’s CHIP, provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

• Montana Dental Association
• Low-fee dental clinics in Montana
• Montana Healthcare Programs
• HealthCare.gov