Insurance Broker Blog

Pediatric Dental: ACA Age Limit Confusion Made Clear

Word on the street is that there is some confusion about the age limit for pediatric dental under the Affordable Care Act (ACA).

Does coverage end at 19 when most pediatric benefits do? Or, does it continue because dependents are now covered until age 26?

Let's clear up the ACA age limit confusion.

Kaiser Health News says that under the ACA, pediatric services, including dental and vision benefits, are covered as an essential health benefit until a child reaches age 19, with no annual or lifetime limits on coverage. It's important to note that this provision only applies to non-grandfathered plans in the individual and small group markets. Benefits may be offered as part of a plan or as a stand-alone, depending on the state. States can choose to provide coverage beyond that limit, but it’s not a requirement.

Large group plans may also offer dental coverage for children--but it’s not mandatory. If it is offered, kids may be covered under the same plan as their parents, with no pediatric age limits. These plans, however, typically have dollar or other coverage limits.

The ACA allows children with individual, small and large group health insurance to remain on their parents’ plan until they turn 26. And, adult children insured under their parents' large group plans may be able to also keep their dental coverage until they turn 26.

For children enrolled in individual or small group plans, once they turn 19 and are no longer eligible for pediatric dental benefits, there are options. Coverage doesn’t necessarily have to end. In this case, when they turn 19, some dental plans allow them to purchase an adult dental one. 

ACA Pediatric Rules Have you Confused? Simplify it by downloading our FREE Guide!

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