Signing up for dental insurance depends on where it comes from: workgroup plans or individual policies (also called individual plans). Open enrollment periods usually occur around November/December for group and Medicare Advantage plans.
However, you can purchase dental insurance outside of open enrollment if a qualifying life event arises.
Group Plans
Open enrollment is an ideal time for workplace dental insurance plans to make any necessary adjustments, such as adding or changing coverage, such as adding vision coverage. When making these decisions, take your time reading all available plans’ details before comparing their benefits side-by-side so you can select one that best meets your needs and budget.
Dependent upon your employer and plan type, open enrollment might not be the only time of year when you can make changes to your dental and vision coverage. Many private dental insurers offer individual and family plans available all year-round that adhere to Affordable Care Act regulations while some provide greater flexibility regarding coverage options, costs and benefits.
Many health and wellness companies provide integrated plans that combine medical and dental benefits. You can view them both on-exchange and off-exchange using the Marketplace compare and estimate tool, with premiums often higher than standalone dental or vision insurance, but potentially covering more services at once than traditional individual and family plans.
Medicare Open Enrollment is an ideal time to assess your coverage options and make any necessary modifications. Unfortunately, Medicare does not include benefits for routine dental care; you would therefore require separate dental coverage plans.
Medicare open enrollment periods do not provide the only opportunity to purchase dental coverage, however. You can enroll outside of them if a qualifying life event (QLE), such as marriage, divorce or having a baby occurs. You could also utilize health savings accounts (HSAs) and limited purpose flexible spending accounts (LP-FSAs), both of which allow users to set aside pretax dollars specifically designated to cover healthcare costs such as dental costs.
Dental and vision coverage can be an incredible motivator in maintaining preventative maintenance practices that could save more expensive treatment in the future. When selecting a plan, take time to understand all available options as well as timelines for making any adjustments – it may even help if you meet with HR professional or individual benefit provider to review available solutions before making the right choice for your individual needs.
Individual Plans
Dental insurance is an important element of overall health and can prevent serious oral health issues in the future. Not only can regular cleanings and checkups prevent serious oral issues from emerging, but dental insurance also detects early stage tooth decay and gum disease that can be treated before it progresses to more serious problems. Therefore, it’s crucial that individuals find an individual plan or add-on plan that suits their specific needs – with many options available out there available now!
If your health and dental insurance are provided through work, there may be an open enrollment period each year to make changes to your coverage. This typically falls in November/December and should be communicated to employees by their HR team. Furthermore, many employers host informational meetings prior to open enrollment to help their employees understand their options and the process involved.
Individuals who obtain health and dental coverage through the Marketplace have specific times throughout the year when they can enroll in these plans, known as open enrollment, which typically occurs around November/December with plans becoming effective January 1. If individuals miss this window of enrollment due to an unexpected life event or circumstances beyond their control, special enrollment periods are also available that allow for special enrollment opportunities.
On-Exchange Plans: Marketplace insurance buyers have many dental and vision options to select from that meet ACA regulations, offering standardized coverage options and benefits. On-exchange plans are suitable for individuals, families and seniors.
Off-Exchange Plans: Off-exchange markets offer several dental and vision plans suitable for individuals and families, offering more flexible coverage options and benefit structures than those provided through Exchange. However, these plans do not qualify for premium tax credits or other subsidies offered under ACA.
Off-exchange plans tend to be more costly than their on-exchange counterparts and should only be considered by those able to afford higher out-of-pocket expenses.
On-Exchange Plans
Dental coverage is often available as an add-on to various health plans on the Marketplace, while others provide separate dental plans with separate premiums. When shopping on the Marketplace, use our Compare Plans and Estimate Cost tool to compare available plans side-by-side.
If your health care is provided through an employer, open enrollment periods offer you an opportunity to select new dental plans annually. Each company’s HR team should provide all the resources and information necessary for making an informed choice when selecting benefits.
Individuals purchasing their individual health insurance through the Affordable Care Act’s Health Insurance Marketplace also can purchase on-exchange dental and vision plans that adhere to ACA regulations, providing standardized coverage options and benefits. Individuals may also buy off-exchange dental and vision policies directly from insurers.
As you explore health and dental options, pay special attention to out-of-pocket limits of plans you are considering. These maximums represent how much money would have to come out of pocket during an entire plan year after meeting all deductible and copay/coinsurance payments; additionally, take note of waiting periods associated with various care services.
Dental procedures such as crown or other restorative work often have a waiting period of 6-12 months before being covered, to deter individuals from seeking immediate treatment without consideration of cost implications later. This policy also encourages doctors and dentists to recommend services only when absolutely necessary, rather than seeing every needful procedure as soon as they arise.
As previously discussed, individuals seeking dental or vision insurance outside of an open enrollment period must experience an eligible life event such as experiencing an income change that makes them eligible for lower-cost or free plans, marriage or having children as qualifying life events. Other events could also qualify such as losing healthcare coverage elsewhere or moving states/areas/undergoing major medical procedures.
Open Enrollment Period
At open enrollment for dental insurance, it’s crucial that you assess your needs and decide if there’s anything missing in your current plan. Doing this will prevent confusion and ensure you have coverage when needed.
Timelines for open enrollment vary based on your specific circumstances. If your dental coverage comes through an employer, they should host informational sessions prior to open enrollment starting so that you fully comprehend all available options and can make informed decisions when making decisions about plans that suit your unique needs. They might even provide lists of eligible providers so they can assist in selecting an optimal plan.
Open enrollment for group plans and the Affordable Care Act generally occurs each fall or winter, while for seniors on Medicare open enrollment typically takes place from November through mid-December.
Once the open enrollment period closes, any modifications to your medical or dental plan may only be possible at next year’s open enrollment period; however, if a qualifying life event arises during that year you may be able to enroll outside the open enrollment period.
Life events that qualify as qualified life events include losing other health coverage, changing jobs, getting married or divorced, having a baby, moving states and more. To qualify, proof must be provided of this event within 60 days and your special enrollment period request submitted as soon as possible after.
Employer plans typically offer you the ability to add dental insurance during open enrollment period, providing comprehensive medical and dental coverage. Individual marketplace plans also have many dental/vision carriers that provide year-round coverage; find them by searching online for their name. You can then read up on any policies offered and examine if they meet your needs.
