Dental Insurance PA Plans for Individuals and Families

If you're a Pennsylvania resident looking for dental insurance, there are several options available to you, including individual and family plans.

Many dental insurance plans in PA offer a range of services, including routine cleanings, fillings, and extractions, as well as more complex procedures like crowns and root canals.

Some plans may have a waiting period before you can use certain services, such as cosmetic procedures or oral surgery.

Dental insurance can help you save money on out-of-pocket expenses and ensure you receive regular dental care to maintain good oral health.

Choosing a dental insurance plan in PA can be overwhelming, but let's break it down. There are two main types of plans: individual dental insurance and DHMO-type dental plans.

You can choose from plans with varying levels of coverage, such as Basic and Premium plans. The Basic plan starts at $20.99/month, while the Premium plan starts at $17.32/month.

Here's a comparison of the two plans:

Ultimately, the choice between a PPO and a DHMO-type plan depends on your oral health needs and financial situation.

Choosing the right dental insurance plan can be overwhelming, but it's essential to make an informed decision. You can choose from individual dental insurance plans in PA or DHMO-type dental plans in PA.

Delta Dental offers two main plan types: PPO and DHMO-type. PPO plans don't have fixed prices, but they'll still help pay for covered procedures even if you see an out-of-network dentist. DHMO-type plans have fixed copays for procedures, but you'll only enjoy coverage at your chosen DeltaCare USA dentist.

To help you decide, let's break down the key differences between these plans. Here's a comparison of the two:

Basic and Premium plans are available within the PPO and DHMO-type plans. The Premium plan offers more comprehensive coverage, including a higher maximum plan pays per calendar year ($2,000 vs. $1,000) and a wider range of services covered without copayments.

Stand-alone pediatric plans on the exchange are a viable option for families. These plans are compliant with the ACA's pediatric dental coverage rules.

The out-of-pocket costs for pediatric dental care on a stand-alone dental plan obtained via Pennie won't be more than $400 per child in 2024. This limit increases to $425 per child in 2025.

For families with multiple children, the out-of-pocket maximum is $800 in 2024, and $850 in 2025. There is no cap on medically necessary pediatric dental benefits for these plans.

If a medical plan has embedded pediatric dental benefits, the maximum out-of-pocket limits mentioned above are not applicable. However, there will be no limit on how much the plan will pay for pediatric dental care.

When choosing a dental plan, it's essential to consider the coverage trend and maximum benefits. The chart for our Pennsylvania dental plan study shows a range of coverage trends.

Some dental plans, such as those from Nationwide and Humana, offer generous plan maximums, with one plan having a maximum of $3000.

Immediate coverage with no waiting periods for most services is available with some dental plans. This can be a significant advantage for those who need dental care quickly.

Some dental plans offer combined vision benefits with standard dental care, making it a convenient option for those who need both services.

Dental insurance in Pennsylvania can be a bit overwhelming, but let's break it down.

Premiums for dental insurance in Pennsylvania can range from $7.89 to $94.99 per month, depending on the plan and provider. The average monthly premium is $39.79.

If you're an adult purchasing your own dental coverage through the exchange, premiums can range from $4 to $38 per month.

There are also dental discount plans available, which are not insurance but can offer discounted rates at participating dentists.

Here are some common types of dental plans available in Pennsylvania:

Most plans have a deductible, with an average of $56.41 per enrollee. Some plans have no deductible, while others have a deductible that's waived for certain preventive services.

Family deductibles are typically higher than individual deductibles, with some plans capping the maximum annual deductible for a family.

You have the freedom to choose a plan that fits your needs. From preventive care to coverage for major procedures, you can select what works for you.

Specific plans available may vary by zip code. So, be sure to check the options in your area.

There are different types of plans to consider, including individual dental insurance plans and DHMO-type dental plans in PA.

You can choose from plans starting at $20.99/mo⁶ for the Basic plan and $17.32/mo⁶ for the Premium plan.

Here are some key features to compare:

Keep in mind that waiting periods apply to some services. For the Basic plan, there's a 30-day waiting period for Basic services, while the Premium plan has a 30-day waiting period for Basic services and a 12-month waiting period for Major services.

The Maximum plan pays per calendar year for the Basic plan is $1,000, and for the Premium plan, it's $2,000.

Overall, Delta Dental plans in Pennsylvania have a high satisfaction rate among members, with 93% reporting satisfaction with their coverage, 98% feeling their in-network dentist is a good match, and 99% being happy with the quality of care received.

If you're looking for dental insurance options in Pennsylvania, you're in luck. Eight insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in Pennsylvania.

To get started, you can check out the list of insurers that offer dental coverage through the Pennsylvania marketplace:

These plans can be purchased through Pennie during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event.

DeltaCare USA is a DHMO-type plan that offers affordable dental insurance options. Starting at just $17.32/month, it's a great choice for those on a budget.

DeltaCare USA plans cover implant-related procedures, but not the full implant procedure. You'll need to check the policy for a complete description of plan benefits, limitations, and exclusions.

DeltaCare USA plans are underwritten by various entities in different states, including Delta Dental Insurance Company, Alpha Dental Programs, Inc., and Delta Dental of Pennsylvania.

Discount Plan vs. Insurance: What's the Difference?

Discount dental plans offer savings on dental procedures compared to retail rates.

One major difference between discount plans and insurance is the network of participating dentists. Discount plans typically have a narrow network, while PPO insurance allows the use of out-of-network dentists.

You may be able to save money with a discount plan, but you'll be limited to a specific group of dentists.

PPO insurance, on the other hand, may make sizable contributions to the cost of major dental care.

Here's a quick comparison of the two options:

Pennsylvania's Medicaid program provides extensive dental services to adults and children, including non-cosmetic care for adults over 21.

Children in Pennsylvania's Medicaid program receive dental services through Rite Smiles, a dental plan that covers all non-cosmetic dental care.

In California, DentaQuest has been selected to administer dental benefits for the Medicaid DMC Program, serving nearly half a million Californians across all dental benefits programs.

Adults in Pennsylvania's Medicaid program are not eligible for orthodontia or general anesthesia, but can receive all other non-cosmetic dental care.

Rite Care is Pennsylvania's CHIP program, providing coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.

If you're looking for insurance options in Pennsylvania, you're in luck because there are several companies that offer dental coverage. Eight insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in Pennsylvania.

These companies include BEST Life, Delta Dental, DentaQuest, Dominion National, EMI Health, Guardian, Humana, and Solstice. You can find a dentist you trust because three out of four U.S. dentists are in the combined networks of these companies.

You can purchase these plans through Pennie, the state-run health insurance exchange, during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event. This is especially important because exchange-certified stand-alone dental plans are compliant with the ACA’s rules for pediatric dental coverage.

Here are the eight insurers that offer stand-alone individual/family dental coverage through the health insurance marketplace in Pennsylvania: