Parents often assume that if dental care for kids is an essential health benefit under the ACA, it must be included in their family health plan. Sometimes it is. Often it is not. Here is how pediatric dental actually works on the marketplace.
What the ACA requires
The ACA lists ten categories of essential health benefits. One of them is pediatric services, which includes oral care for children. Adult dental is not an essential health benefit.
Why your health plan may not include it
Pediatric dental can be offered two ways on the marketplace:
- Embedded — built into the medical plan, with children's dental covered under the same policy.
- Stand-alone — sold as a separate dental plan alongside the health plan.
Because stand-alone dental plans exist, many medical plans do not include children's dental at all. If you pick one of those plans, you may need to add a separate dental plan to cover your kids.
How to tell which you have
- Check the plan's Summary of Benefits and Coverage under children's dental.
- Look for a "dental coverage included" note in the plan details.
- Ask the marketplace or your agent directly before you enroll.
What children's dental usually covers
- Routine exams and cleanings
- X-rays and fluoride treatments
- Sealants
- Fillings and basic restorative care
- Medically necessary orthodontics in some plans
Cosmetic orthodontics is usually not covered by the pediatric benefit. For adults' braces, see adult orthodontic coverage.
Costs and subsidies
When pediatric dental is embedded in a medical plan, premium subsidies apply to the whole plan. When it is sold separately, part of the premium may be taken into account in some subsidy calculations, but stand-alone dental plans have their own premiums and out-of-pocket limits. Compare total cost both ways.
Other options for kids
- Medicaid and CHIP cover children's dental in every state for eligible families — see our Medicaid eligibility guide.
- Employer plans may offer family dental coverage.
Children's vision is handled differently — read kids' vision coverage under the ACA.
Want a family plan that covers your kids' dental care? Our free tool compares plans across top carriers and shows what you would actually pay in about 60 seconds — no obligation, and a licensed agent reviews your options with you. Get your free quote →