President Obama signed the Affordable Care Act (ACA), or Obamacare, into law in March 2010. It was a landmark legislation aimed at expanding healthcare access in the United States, with about 40 million people benefiting from ACA enrollment as of 2023. For reference, nearly 50 million U.S. individuals had no health insurance when the reform was introduced. But does Obamacare cover dental insurance?
While the ACA significantly improved access to healthcare coverage, particularly for those without employer-sponsored insurance, some questions remain about dental care. The law introduced provisions to expand health benefits. However, adult dental coverage is not included in the standard package, leaving many individuals navigating the complexities of additional coverage options.
HealthPlusLife is a trusted partner of insurance agencies, ready to help anyone asking, “Does Obamacare cover dental?” and provide general information on the framework of the ACA. Our team of specialists can help you fully understand dental coverage under Obamacare.
Under Obamacare, braces are generally not covered for adults. However, there are specific circumstances where dental coverage, including orthodontic care like braces, may be covered for children.
The ACA requires that pediatric dental services be included as one of the essential benefits of the health plans available through the Marketplace. This means that if you purchase plans through the insurance Marketplace, your coverage must include dental coverage for children under 19, including braces if medically necessary. However, this coverage is not automatic and may require additional premium payments for a standalone dental plan or one offering dental benefits.
For adults, orthodontic treatment like braces is generally not covered unless it is medically necessary due to specific medical conditions. Even then, it would need to be part of a broader medical plan. In such cases, coverage is often limited or requires additional insurance options outside the standard ACA coverage.
As a result, individuals seeking this treatment may need to explore additional dental insurance options.
Does Obama Care Cover Wisdom Teeth Removal?
Obamacare dental coverage for wisdom teeth removal can depend on several factors, including the nature of the procedure (whether it’s medically necessary or elective) and your type of health plan.
Medically Necessary Wisdom Teeth Removal: If wisdom teeth removal is deemed necessary, your health insurance plan may cover it under the ACA. Most health insurance policies, including those offered through the Health Insurance Marketplace, cover medically essential oral surgery. However, the specifics can differ depending on your plan. Some health insurance plans require pre-authorization or specific documentation to prove the procedure’s medical necessity.
Elective Wisdom Teeth Removal: If you are having your wisdom teeth removed for reasons other than medical necessity (such as preventive extraction before they cause problems), this may not be covered under your ACA health plan. Most ACA-compliant plans only cover routine dental procedures like elective tooth extractions if they are part of a broader dental plan. You would need dental insurance for routine dental care, often purchased separately or as a supplemental plan alongside your health insurance.
Carefully review your health plan to understand what is covered and whether extra coverage, like a separate dental plan, is necessary. If you have trouble navigating the ACA Marketplace and finding health insurance, don’t hesitate to reach out to us at HealthPlusLife.
What Are the 10 Essential Coverages of Obamacare?
Obamacare mandates that all health insurance plans offered through the Health Insurance Marketplace and those provided by employers cover 10 essential health benefits. These benefits guarantee that individuals have access to critical healthcare services.
These benefits are as follows:
Ambulatory Patient Services (Outpatient Care): This includes services that do not require an individual to stay overnight in a hospital. It covers doctor visits, diagnostic tests, minor surgeries, and treatments performed in outpatient settings like clinics or physician offices.
Emergency Services: Plans must cover emergency services without requiring prior approval or considering whether the provider is in-network.
Hospitalization: Hospital services, including inpatient care, surgeries, treatments, and any required follow-up care, must be covered.
Maternity and Newborn Care: Health plans must cover pregnancy, childbirth, and newborn care services.
Mental Health and Addiction Services: This category includes behavioral health services, mental health treatment, and substance use disorder services (inpatient and outpatient).
Prescription Drugs: Health insurance plans must cover a range of prescription medications. The specific drugs covered will vary by plan, but all plans must offer a list of covered drugs, including generic and brand-name medications.
Rehabilitative Services: These include physical, occupational, and speech therapies.
Laboratory Services: Health insurance must cover laboratory tests, including blood work, screenings, and diagnostic tests, which are necessary to diagnose and monitor conditions.
Preventive Wellness Support and Chronic Disease Care: This benefit covers preventive care, which includes routine check-ups, vaccinations, cancer screenings, and services to help manage chronic diseases like diabetes, asthma, and heart disease.
Pediatric Services: This benefit covers healthcare services for children under 19. It includes routine doctor visits, immunizations, vision, and dental care.
These ten essential health benefits ensure that individuals can access the medical services needed to maintain health and well-being. Enrolling in the insurance Marketplace can give you peace of mind about a wide range of health concerns, and Health Plus Life can help you seamlessly navigate the intricacies of the process. Knowing what areas of dental Obamacare does and does not.
Why Is Dental Insurance Separate From Health Insurance?
Dental insurance is separate from general health insurance because of the different natures of care and cost structures. Dental care primarily focuses on preventive services, like cleanings and check-ups. Meanwhile, general health insurance covers broader medical treatments such as surgeries and hospitalizations.
Historically, dental and health insurance are provided separately. Dental care was seen as a specialized service with more predictable costs. As a result, dental insurance plans are typically lower-cost, emphasizing routine care. However, health insurance covers higher-risk, expensive medical services.
Under Obamacare, dental coverage for children is considered an essential health benefit. Yet, adult dental care is not required for basic health plans. This distinction allows consumers to choose separate dental plans based on their needs through standalone policies or as an add-on to health insurance. Choosing your own plan can take the guesswork out of the equation and allow you to know exactly what your Obamacare provider does and does not cover for dental.
Get Answers to the Question, “Does Obamacare Cover Dental?” Today, by Contacting HealthPlusLife
If you’re wondering does Obamacare cover dental insurance services, it’s important to understand the specifics. HealthPlusLife can help you explore your options and get specialized guidance to find the right coverage.
In January, the Biden Administration announced just over 21 million people had selected a plan through the ACA Insurance Marketplace in 2024. The initiative has saved the lives of millions and could provide priceless peace of mind regarding healthcare.
Reach out to HealthPlusLife today at 888-828-5064 for more information on whether Obamacare does or does not cover dental and more. We’re happy and ready to help.
Johanna Karlsson Johanna Karlsson is a veteran health and life insurance professional licensed in 50 states. She relocated from the countryside in the south of Sweden and has not looked back. After coming to the United States to attend university, she gained her degree in Public Relations. She brought her public relations skills to a local international health insurance where she discovered a new passion in insurance. After years with that company, Johanna now joins HealthPlusLife to help build a team of licensed insurance agents ready to meet your insurance needs.
