Utah dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange in Utah, premiums in May 2024 ranged from about $12 to $63 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 pediatric stand-alone dental plans available in the Utah health insurance marketplace 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)

According to a Milliman analysis of 2024 coverage, none of the medical plans available through the health insurance Marketplace in Utah include embedded pediatric or adult dental coverage.¹ So the only way for Utah Marketplace enrollees to obtain dental coverage is via a stand-alone dental plan, which can be purchased in conjunction with a health plan.

As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care are guided by the state’s essential health benefits benchmark plan.

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

In Utah, there are also dental discount plans available for purchase. Dental discount plans are not insurance, but can offer discounted rates 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.

Adults enrolled in Medicaid in Utah are eligible for limited emergency dental services. Children enrolled in Medicaid who qualify for CHEC are eligible to receive more robust benefits up to the age of 21.

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

• Utah Dental Association
• Utah free or low-cost dental clinics
• Utah Medicaid
• HealthCare.gov