Virginia dental insurance guide

For adults who purchase their own stand-alone dental coverage through the exchange, premiums in July 2024 range from $8 to 33 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.

All stand-alone pediatric dental plans available in Virginia on the Marketplace will comply with the Affordable Care Act’s (ACA) pediatric dental coverage rules. This means out-of-pocket costs for pediatric dental care on a stand-alone dental plan purchased through the Marketplace will not exceed $400 per child in 2024 (or $800 for all the children on a family’s plan) 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.)²
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.
The specific coverage requirements for pediatric dental care – either embedded in an ACA-compliant individual market plan, or obtained via the Marketplace as a stand-alone dental plan – must follow the state’s essential health benefit (EHB) benchmark plan.
Virginia’s benchmark plan includes 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, with coverage available for both adult and pediatric dental services. 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 Old Dominion State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the  Virginia State Corporation Commission (SCC). If you would like to purchase a non-ACA qualified dental plan, talk to your agent or search online.

In Virginia, there are also various dental discount plans available. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Here’s useful information about the  differences between dental insurance and dental discount plans.

To find plans in your area, search online for dental discount plans and Virginia.

Both children and adults enrolled in Medicaid in Virginia have comprehensive dental coverage.³ The benefits were expanded for adults starting in 2021.⁴

FAMIS, Virginia’s CHIP, provides dental coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

• Virginia Dental Association
• Virginia free or low-cost dental clinics
• Virginia Medicaid
• Virginia Health Insurance Marketplace (new as of 2024; Virginia previously used the HealthCare.gov Marketplace platform)