Illinois uses the federally facilitated health insurance Marketplace HealthCare.gov for the sale of certified individual/family dental plans.
Not all insurers who offer medical plans through the Illinois exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children.
For adults who purchase their own stand-alone dental coverage through the exchange in Illinois, premiums in May 2024 ranged from about $8 to $57 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 in the Illinois exchange (Marketplace) must comply with the ACA’s pediatric dental coverage rules.
This means out-of-pocket costs for pediatric dental care will not exceed $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.
If a medical plan has embedded pediatric dental benefits, the maximum out-of-pocket limits described above are not applicable (the services can be counted towards the regular medical deductible). But since pediatric dental care is an essential health benefit, there will be no limit on how much the plan will pay for this care.
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.
The Illinois 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 in Illinois. These are dental plans that are not included with a medical plan and must be purchased separately.
This coverage 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 Illinois. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Illinois Department of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
There are also various dental discount plans available in every state. 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 enrolled in Medicaid in Illinois are eligible to receive extensive dental services through the state’s managed-care organizations (MCOs). For adults and children in Medicaid but not in an MCO, they will need to contact a state-designated insurer to locate a dentist.
All Kids, which is Illinois’s CHIP, provides coverage to uninsured children and new mothers with income above the eligibility limits for Medicaid.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
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