Pennsylvania dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in Pennsylvania, premiums in May 2024 ranged from about $4 to $37 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 via Pennie (Pennsylvania’s state-run health insurance Marketplace) are compliant with the ACA’s pediatric dental coverage rules.

This means the out-of-pocket costs for pediatric dental care on a stand-alone dental plan obtained via Pennie 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 obtained via Pennie as a stand-alone dental plan) are guided by the state’s essential health benefits benchmark plan.

The Pennsylvania benchmark plan does include coverage for both basic and major dental services for children.

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

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

In Pennsylvania, there are also various dental discount plans available. 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 and children enrolled in Medicaid in Pennsylvania are eligible for extensive dental services. For adults (age 21 and over) that does not include orthodontia or general anesthesia, but does include all other non-cosmetic dental care.

For children (up to age 18) the state’s Medicaid dental services are run through a dental plan named Rite Smiles.

Rite Care is Pennsylvania’s CHIP, and it provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

• Pennsylvania Dental Association
• Low-fee dental clinics in Pennsylvania
• Pennsylvania Medicaid (MA)
• Pennsylvania CHIP
• HealthCare.gov