Tennessee dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in Tennessee, premiums in May 2024 ranged from about $8 to $43 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.

The stand-alone pediatric dental plans available in Tennessee’s health insurance Marketplace (HealthCare.gov) will comply 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 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)

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.

According to a Milliman analysis of 2024 coverage, some medical plans available through the health insurance Marketplace in Tennessee include embedded pediatric and adult dental coverage (note that there are no coverage rules for adult dental, so it can have benefit caps).¹ There are also stand-alone dental plans available.

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 HealthCare.gov as a stand-alone dental plan) are guided by the state’s essential health benefits benchmark plan.

You can review details of the Tennessee benchmark plan, which does include coverage for both basic and major dental services for children.

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

These plans 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 the Volunteer State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Tennessee Division of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.

In Tennessee, there are also various dental discount plans available. Dental discount plans are not insurance, but they can get consumers lower 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.

Beginning in 2023, adults enrolled in Medicaid in Tennessee, known as TennCare, became eligible for dental benefits. Extensive dental benefits for pregnant and postpartum beneficiaries began in April of 2022. Children enrolled in Medicaid are eligible to receive comprehensive dental benefits as long as they are deemed medically necessary.⁵

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

• Tennessee Dental Association
• Low-fee dental clinics in Tennessee
• Tennessee Medicaid
• HealthCare.gov