Carlton Insurance LLC

Dental care is an important element of total health. Preventive services including dental exams, X-rays and cleanings often save you money over time. Maintaining healthy teeth and gums can help minimize major dental procedures in the future.

With the implementation of the Affordable Care Act, beginning January 1, 2014, there is a requirement in most states for “qualified health plans” to provide “preventive dental and vision” services for children under 19 years of age only. This is often referred to as “pediatric dental.” Some plans embed the pediatric dental benefit; others do not. Some carriers in some states allow adult-only plans to be compliant with the law by adding the benefit but not charging an additional premium as long as there are no members under 19 years of age. Other carriers require adults purchase separate dental plans to cover adults if the medical plan does not include the pediatric dental benefit. This is one of the most complex areas of the law. Non-compliance can have dire consequences including the carrier’s termination of your plan (back to the initial purchase date) if they learn you did not purchase adult dental separately if your medical plan doesn’t include the pediatric dental.

Depending upon the make-up of yourself or your family as well as the legal and tax implications, the decision to purchase dental insurance or not should be carefully considered.

Individual/Family DENTAL
Regardless of whether you want coverage for your children under 19 years of age, you may or may not wish to have dental insurance for the adults in your household. Dental insurance for individuals and families will pay out $500 - $2000/person/year. Most plans do not cover implants or orthodontia but focus on preventive services (e.g., cleanings, exams, X-rays), basic services (e.g., fillings) and major services (e.g., crowns). Each plan has specific definitions for each level of services and it is important to consider these definitions prior to purchase.

In order to determine whether dental insurance is right for you, consider the following questions:
  • How much do I/family members spend on dental services in a year? If I purchase dental insurance, will I at least break even on the premiums I will pay?
  • Is it important to me/family members that we visit a particular dentist? Is this dentist in the network of the dental plan?
  • What is the maximum amount of dental coverage provided by the dental insurance plan, per person, per year?
  • Is orthodontia covered under the dental plan?
  • Are preventive services (typically dental exams, cleanings, X-rays) subject to the annual deductible and covered at 100% from day one of the policy?
  • Which specific services are covered as “preventive,” “basic” and “major” services for the plans under consideration?
  • Is there a waiting period for any services (typically there is a waiting for major services including crowns, but some plans have waiting periods for more basic services as well)?

These are just some of the important questions that can arise during your dental insurance purchase decision. If you need assistance in seeking answers to any of these questions or wish to purchase dental insurance, please call or
e-mail me.

This web site may contain concepts that have legal, accounting and tax implications. It is not intended to provide legal, accounting or tax advice. You may wish to consult a competent attorney, tax advisor, or accountant.