Washington uses a state-run health insurance Marketplace named Washington Health Plan Finder for the sale of certified individual/family dental plans.
The medical plans available through Washington Healthplanfinder (the state-run exchange) do not include embedded dental benefits. The only way to obtain dental benefits in Washington’s exchange — for children or adults — is with the purchase of a stand-alone dental plan. 1 (Apple Health, Washington’s Medicaid program, does include dental coverage, and enrollees do not need to obtain a separate dental plan. 2 )
For adults who purchase their own stand-alone dental coverage through the exchange in Washington, premiums in May 2024 ranged from about $15 to $41 per month. 3
If a family is purchasing coverage through the Washington Health Plan Finder, 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 plans available via Washington Healthplanfinder (the state-run 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 Washington Healthplanfinder won’t be more than $400 per child in 2024 (or $800 for all the children on a family’s plan), 4 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. 5 )
Unlike most states, the medical plans available through Washington Healthplanfinder do not include any embedded dental benefits. So a stand-alone dental plan is the only way to obtain pediatric or adult dental benefits in Washington’s exchange. 1 (Apple Health, Washington’s Medicaid program, does include dental coverage, so Apple Health enrollees do not need to buy a separate dental plan. 2 )
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care on the stand-alone plans offered via Washington Healthplanfinder are guided by the state’s essential health benefits benchmark plan.
You can see details here for Washington’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2024, nine insurers offer stand-alone individual/family dental coverage through Washington Healthplanfinder. These are dental plans that are not included with a medical plan and must be purchased separately.
These plans can be purchased through Washington Healthplanfinder 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 also a variety of dental insurers that sell stand-alone dental plans directly to consumers in Washington. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Washington Division of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
There are also various dental discount plans available in every state. 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.
For both adults and children enrolled in Medicaid in Washington (Apple Health), various dental services are covered. 6
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.
