You can get dental insurance year-round as long as it isn’t bundled with your health plan and isn’t regulated by the Affordable Care Act.
For millions of Americans, the individual health insurance market is the ideal place to buy medical insurance, especially if they’re not covered by an employer-sponsored program. This health insurance marketplace has an open enrollment period, which is essentially the time of the year when you’re required to sign up for health benefits including dental coverage for the upcoming year.
In most cases, open enrollment usually comes into effect 30 to 60 days before your new health insurance plans take effect. This period technically allows you to change, add, or cancel a particular coverage for the next 12 months. That being said, what happens if you don’t sign up for dental insurance during open enrollment? Well, let’s find out.
Do you have to wait for open enrollment for dental insurance? No, you can buy dental insurance year-round if it’s not bundled with your overall insurance health plan and not regulated by the Affordable Care Act. There are a few exceptions that can allow you to get dental insurance coverage outside open enrollment.
Whether you signed up for dental insurance during the open enrollment period or couldn’t hit the deadline, there are a few ways to buy dental insurance year-round, and that’s what this article is all about.
Native Americans and those Eligible for Medicaid
You necessarily do not have to wait for open enrollment to sign up for dental insurance if you are a Native American. This means that you can take advantage of the special enrollment period and sign up for dental insurance at any time of the year.
Similarly, you do not have to wait for open enrollment to sign up for dental insurance, or any other medical plan for that matter if you qualify for Medicaid or CHIP. This means that you can buy dental insurance at any time.
You, however, have to keep in mind that income limits can be quite exorbitant for those eligible for CHIP. As such, make sure to check out the eligibility limits in your state without just assuming that your kids may not be eligible. Remember, these benefits can be extended to middle-class households but this depends on the states.
Again, you can enroll for dental insurance if you are on Medicaid but you experience an increase in income levels to a point where you’re no longer eligible for Medicaid. In essence, you won’t have to wait for open enrollment to sign up for dental insurance; you can switch to a private dental plan at that point.
In short, losing your eligibility for a Medicaid plan as a result of an increase in income is generally treated as a qualifying event that instantly triggers a special enrollment period.
Qualifying Life Events (QLE)
Several factors such as getting married or divorced, losing your job, having or adopting a child, or starting a new job are known as qualifying life events and can give you access to a special enrollment period. It doesn’t matter the type of health insurance plan that you have, such events give you the chance to shop for dental insurance or any other health insurance plan.
Of course, you’ll have to offer proof of evidence that you had a QLE to be eligible for a special enrollment period. You have to keep in mind that the rules limit a special enrollment period to the same type of plan that you initially had.
For instance, you might not be allowed to switch to a more or less robust dental insurance plan. You may change to almost the same level of plan and you cannot necessarily go from being uninsured to being insured mid-year just because of a particular QLE.
Again, you’ll be required to provide proof of your previous dental insurance coverage on top of proof of the qualifying life event. For example, if you want to change your dental insurance because you’re getting married, you’ll be required to offer proof of marriage and at least you or your spouse must have already had health coverage for the marriage to initiate a special enrollment period.
Without a QLE, getting major medical health insurance such as dental insurance may not be possible. Before 2014, getting health insurance in the individual health insurance marketplace could happen at any time but this is no longer the case
The Type of Your Dental Insurance Plan Matters
As we noted earlier, you may not be able to buy dental insurance if your dental insurance coverage is bundled with your health plan and you didn’t sign up during open enrollment. Again, it may be impossible if you are ineligible for Medicaid, CHIP, or employer-sponsored coverage. Your options may become even more limited if you are not expecting any qualifying life event during the year.
That being said, your best option for getting dental insurance would be to target dental insurance policies that aren’t covered or regulated by the Affordable Care Act (ACA), popularly known as Obamacare. Such coverage plans are generally considered to be supplemental coverage and not your only health insurance coverage. They often include dental/vision plans, accident supplements, medical discount plans, and critical/specific illness policies.
This would mean that you buy a dental insurance plan separately and not bundled with your overall health plan. By doing so, you’ll not only enjoy numerous benefits but will also get dental insurance plans year-round without getting limited by open enrollment or special enrollment period.
For many people, the end of open enrollment may seem like a door-slamming shut in their plans to buy their health coverage options. Whether you’re healthy or have had continuous coverage, most plans are not available at any time of the year unless there’s a qualifying life event such as marriage or divorce that can trigger a special enrollment period.
For your dental insurance, however, you can buy it at any time of the year as long as the policy is not regulated by the Affordable Care Act and is considered to be supplemental coverage.
Things to Consider When Enrolling for a New Dental Insurance Plan
Whether you’re able to buy dental insurance through open enrollment, a special enrollment period, or at any time of the year, here are some important things to consider.
Covered Treatments and Procedures
Dental plans are unique and can be designed to cover specific dental needs. It’s, therefore, very important that you take a keen look at what’s covered by your plan. You can choose a prevention-only plan if you’re healthy and do not expect major treatments other than normal cleanings and checkups.
On the other hand, you can choose a dental plan that offers other services such as crowns or fillings if you anticipate that you might need such services.
Monthly Premium
This is the amount that you’re expected to pay every month. Different plans have different premiums so it depends on what meets your dental needs and fits your budget.
Deductibles
Some dental plans have deductibles. This is the amount that you have to pay before your dental benefits come into play.
Out-of-pocket Maximums
This is the maximum amount that you can pay during your dental insurance coverage year for the share of the cost of offered services.
Dental Plan Network
A majority of dental plans give you access to Dental Health Maintenance Organization (DHMO) or Preferred Provider Network (PPO). DHMO plans generally charge a certain fee for services and offer limited access to care while PPO offers their services at discounted rates. You should choose a plan that suits your dental needs.
