West Virginia uses the federally facilitated health insurance Marketplace HealthCare.gov for the sale of certified individual/family dental plans.
Some of the health insurance plans available through West Virginia’s health insurance Marketplace include embedded pediatric and adult dental coverage. 1 There are also stand-alone dental plans available.
For adults who purchase their own stand-alone dental coverage through the exchange in West Virginia, premiums in May 2024 ranged from about $12 to $31 per month. 2
If a family is purchasing coverage through the West Virginia 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 pediatric stand-alone dental policies available on the West Virginia health insurance Marketplace (exchange) will comply with the ACA’s pediatric dental coverage rules.
This means the out-of-pocket costs for pediatric dental care on a stand-alone dental plan obtained via HealthCare.gov won’t be more than $400 per child in 2024 (or $800 for all the children on a family’s plan), 3 and there is no cap on medically necessary pediatric dental benefits. (For 2025, the out-of-pocket maximums will increase to $425 and $850, respectively. 4 )
If a medical plan has embedded pediatric dental benefits, the maximum out-of-pocket limits described above are not applicable. However, there will be no limit on how much the plan will pay for pediatric dental care, since it’s an essential health benefit.
According to a Milliman analysis of 2024 coverage, some medical plans available through South Carolina’s Marketplace include embedded pediatric and adult dental coverage. 1 There are also stand-alone dental plans available through the West Virginia Marketplace.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care (either embedded in an ACA-compliant individual market plan, or obtained via HealthCare.gov as a stand-alone dental plan) are guided by the state’s essential health benefits benchmark plan.
You can see details here for West Virginia’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2024, there is only one insurer offering stand-alone individual/family dental coverage through the health insurance marketplace in West Virginia. These are dental plans that are not included with a medical plan and must be purchased separately.
These plans 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 no benefit requirements, however, for adult dental coverage.
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in the Mountain State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the West Virginia Offices of the Insurance Commissioner. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
In West Virginia, there are also various dental discount plans available. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Here’s what you need to know 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 West Virginia are eligible for emergency dental services only, such as procedures to treat fractures, pain or infection. Children enrolled in Medicaid are eligible to receive more comprehensive dental services up to the age of 21.
WVCHIP, which is West Virginia’s CHIP, provides coverage for a broad range of dental services to uninsured children and pregnant women 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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