Affordable Care Act Dental Insurance 2025

In this article:

• ACA enrollment important dates
• What’s new in the ACA for 2025
• ACA dental insurance costs and coverage
• Dental insurance options and dental savings plans

If you’re confused about dental insurance as it pertains to the Affordable Health Care Act – also known as the ACA, Obamacare, heathcare.gov, or the insurance Marketplace – you’ve come to the right place. DentalPlans.com is your one-stop resource for all things dental, from plans that help you save money on dental care and other healthcare needs to providing the information you need to make the best choices for your and your family’s dental health.

Important Dates: ACA Open Enrollment For 2025 Coverage

The annual open enrollment for ACA health coverage begins November 1, 2023. During this period, you can enroll in or change your ACA insurance coverage for 2024.

November 1, 2024 – Open Enrollment starts for health coverage for the next plan year. See your coverage options at Healthcare.gov or your state’s Marketplace.

December 15, 2024 – Last day to enroll in or change plans for coverage to start January 1.

January 1, 2025 – Coverage starts for those who enroll in or change plans by December 15, 2023, and pay their first premium.

January 15, 2025 – Open Enrollment ends — last day to enroll in or change health plans for the year. After this date, you can enroll in or change plans only if you qualify for a Special Enrollment Period.

February 1, 2025 – Coverage starts for those who enroll in or change plans December 16, 2023, through January 15, 2024, and pay their first premium.

States that have their own Marketplaces may have different enrollment dates than above. Check your state’s ACA marketplace for the most current information.

What’s new in the ACA for 2025?

The Centers for Medicare & Medicaid Services (CMS)States have finalized a rule that provides states with option to add routine adult dental services as an essential health benefit to their EHB- benchmark plans starting on January 1, 2027. The application process for states that wish to add expanded adult dental services to benchmark plans begins in 2025. (An EHB-benchmark plan is the standard for essential health benefits within a specific state.)

Some states are offering new or enhanced state-funded subsidies for 2025, including California, Colorado, and New Mexico. Log into your state Marketplace to review new options.

The ACA and Dental Insurance

Very little has changed over the past eleven years regarding the notable lack of dental insurance coverage options for adults under Obamacare. It remains much easier to find dental coverage for your children. That said, you cannot purchase dental insurance alone through the Federal ACA, it still needs to be part of or added to your current ACA healthcare plan.

You can choose from:

Health plans with embedded dental coverage: If a health plan includes dental, the premium – the price you pay – covers both health and dental coverage.

Separate dental plans: If you pick a separate dental plan, you’ll pay a separate premium. This is in addition to the premium you pay for your Marketplace health plan.

The ACA offers two types of dental coverage:

High Coverage Level dental insurance has higher premiums (the amount you pay each month) but lower copays (what you pay out-of-pocket for dental care), and deductibles, (the amount you have to reach before insurance begins to cover services). That means you pay more monthly for a high-level but less when you actually visit a dentist. If you typically need more than basic dental care, you may want a High Coverage plan. But check the annual spending limit, ACA plans typically cap what they pay at between $750-$1,500. Once you reach your limit, you pay out of pocket until your plan renews the next year. (And you’ll have to pay your premiums as well).

A Low Coverage Level plan will cost less in monthly premiums but has higher copayments and deductibles. If you and your family usually just see the dentist for twice-yearly cleanings and a checkup, a low coverage plan may be right for you.

ACA dental insurance costs

Premiums vary widely according to your location and any subsidies you might receive but in general*:

• The lowest cost plans available via Healthcare.gov for a family start at $8/month. At this level plans only offer basic preventive care (exams, x-rays, and cleanings).
• Midrange plans run $25 to $30 a month, typically cover basic and major services, with deductibles ranging from $50-$75. Annual spending limits can be as low as $750, with a few plans capping at $1,500. Most midrange plans have waiting periods of up to 12 months before major services are covered.
• The highest priced plans have premiums ranging from $37 to $56/month. These plans have annual spending limits of $1,000-$1,500, and typically waiting periods of six months for basic services and 12 months for major services.

ACA dental options focus on expanded coverage for children. The out-of-pocket maximum for stand-alone dental insurance plans certified by the Affordable Care Act (ACA) is $375 for one child and $750 for a family with more than one child covered by the plan. These amounts increase for 2024 to $400 for one child and $800 for more than one child. After you reach the maximum, the plan pays 100% of the remaining covered services for that year. This usually applies only to in-network services. Kids may also be able to skip waiting periods for care. Check individual plan details.

Many of the lower and midrange cost plans that we reviewed did not include orthodontia. If your kids need braces, try to find a plan that includes this procedure (or look for another option, like a dental savings plan).

Dental insurance options under the ACA are typically fewer and more expensive for adults. While the cost of coverage can be reduced with subsidies, it still can make sense to explore other options for reducing dental costs such as a dental savings plan.

What are dental savings plans?

Dental savings plans, also known as dental discount plans, are a trusted alternative to traditional dental insurance that provide discounts on virtually all procedures. Plan members report saving an average of 50%** on their dental care. And, unlike dental insurance, dental savings plans have no annual limits, no restrictions on existing health conditions, and your savings start right away, even on restorative care such as root canals, crowns, dentures, and dental implants. Many plans even cover cosmetic dental procedures such as teeth whitening and overlays.

It’s simple to choose a plan at DentalPlans.com, the largest marketplace for dental savings plans and dental insurance. You can compare more than 25 plans from the most trusted brands in healthcare, and easily join your selected plan. Want a personalized recommendation? Take our dental plan quiz online or use the calculator below.

*Based on collated and averaged ACA plan information for Atlanta, GA, Chicago, IL, Des Moines, IA, Miami, FL, New York, NY (state marketplace) and Tampa, FL. 

** Discount Health Program consumer and provider surveys indicate average savings of 50%. Savings may vary by provider, location, and plan.