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Affordable Care Act Includes Dental Care

We’d understand completely if you thought that the Affordable Care Act (ACA) was only about medical care, but the it includes provisions for dental care – especially for children’s dental care.  

Transparency in Coverage - Delta Dental of Iowa policies and practices for ACA individual plans.

Individual and Small Group Plan Options

Delta Dental gives your individual and small group (1 to 50 employees) clients flexibility to choose plans that meet the ACA pediatric dental essential benefit (EHB). These benefits include:

  • Age Limits: The pediatric dental EHB mandates coverage up to age 19, but Delta Dental plans expand the pediatric dental EHB to age 21.
  • Lifetime Maximums: There are no annual or lifetime maximums for children dental benefits.
  • Cost Sharing: The annual out-of-pocket limit for pediatric dental services is $350 per child or $700 for all children for services performed by an in-network provider.  
  • Orthodontia: Medically necessary orthodontia is included and is defined by each carrier. Delta Dental members eligible for medically necessary orthodontia have certain designated syndromes or genetic disorders such as cleft palate.

Coverage for Children up to Age 26 

Children up to age 26 are eligible for coverage under their parents/guardians’ health care plans, regardless of marital status, dependent status, student status or residency. Although this provision does not apply to stand-alone dental or vision insurance, Delta Dental of Iowa applies this coverage to all small group plans and lets large groups choose whether to include coverage for eligible children up to the age of 26.

The content provided is for informational purposes only, and is not intended as legal or tax advice or opinion relative to any specific issue. Additional changes may be made to the Federal or State regulations described in this message. You should consider consulting with your lawyer or tax advisor before acting based on this information.