New York dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in New Jersey, premiums in May 2024 ranged from about $9 to $45 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 stand-alone pediatric dental plans available through NY State of Health 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),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 individual market plan, or sold via NY State of Health as a stand-alone dental plan) are guided by the state’s essential health benefits benchmark plan.

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

In 2024, four insurers offer stand-alone individual/family dental coverage through NY State of Health. These are dental plans that are not included with a medical plan and must be purchased separately.

This coverage can be purchased through NY State of Health during open enrollment (November 1 to January 31; historically open enrollment has begun mid-November in New York, but that’s expected to change to November 1 starting in the fall of 2024) 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.

NY State of Health has a dental plan comparison tool that allows users to compare the available dental coverage options, including stand-alone dental plans and health plans that have embedded dental coverage.

There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in New York. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the State of New York. 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 New York are eligible for dental services through the Healthy New York Plan. Children are also eligible for dental benefits through New York Medicaid.

Essential Plan is New York state’s Basic Health Plan which offers coverage outside the exchange for low income adults. The Essential Plan does provide preventive, routine, and major dental care for adult enrollees.

Child Health Plus, which is New York’s CHIP, provides dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

• New York State Dental Association
• New York Free Dental Clinics
• Healthy New York (Medicaid)
• HealthCare.gov