It’s open enrollment season for Affordable Care Act-compliant (ACA) dental plans on Health Care Exchanges (Marketplaces). Here’s what you need to know to sell ACA exchange plans to your individual clients.

Dates to know

  • November 1, 2021: Open enrollment begins.
  • December 15, 2021: Last day to enroll in or change plans for coverage that begins on January 1, 2022. (Please note that this date may be subject to extension.)
  • January 1, 2022: Coverage begins for those who enrolled by the December due date and have paid their first premium.
  • January 15, 2022: Last day to enroll in or change plans for 2022 coverage in the following states:
    • Federally Facilitated Marketplace states – AL, AR, DE, FL, GA, IA, IL, KS, LA, MI, MS, MT, OK, OR, TX, UT, VA and WV
    • MD, MN, NV, PA, and WA

After this date, individuals must qualify for a Special Enrollment Period to enroll in a new plan or change their current one.

  • January 30, 2022: Last day to enroll in or change plans for 2022 coverage in the following states:
    • CA, NJ and Washington DC.
  • February 1, 2022: Coverage begins for those who enrolled by the January due date and have paid their first premium.

The American Rescue Plan Act of 2021 expanded ACA access

In March, President Joe Biden signed the American Rescue Plan Act of 2021. Among its other effects, this law will lower premiums this year for most people who currently have a Marketplace health plan and expand access to financial assistance. The Centers for Medicare & Medicaid Services released a factsheet that breaks down the steps required for your clients to make the most of this expanded access.

The basics of exchanged-based dental plans

All plans offered through public exchanges are available in two forms:

  • Health plans that include dental coverage
  • Stand-alone dental plans

Both stand-alone plans and bundled plans are available as high and low plans.

  • High plans. These plans feature higher monthly premiums but lower coinsurance and deductibles. These plans may be appropriate for clients who anticipate needing extensive care over the course of the year.
  • Low plans. These plans have lower monthly premiums but higher coinsurance and deductibles. These plans have lower fixed monthly costs but higher out-of-pocket expenses for dental care. These plans may be better for clients who are in good dental health and anticipate only needing routine cleanings and exams.

Dental insurance is an essential benefit for children, but not adults

For children 18 and younger, dental coverage is considered an essential benefit. That means that dental coverage must be made available by insurers, either in the form of a stand-alone plan or as part of a bundled health plan. Because dental coverage isn’t an essential health benefit for adults, insurers aren’t required to offer it.

Selling Covered California has some unique aspects

As a public exchange, Covered California has much in common with other exchanges. However, there are some differences that are unique to California. One of the biggest is these is extra certification requirements beyond the ACA-mandated training.

As an insurance broker, you’re required to have additional certification to sell Covered California plans. Beyond the regular licensing requirements to sell insurance in California, you must also complete online course, pass an exam and submit various paperwork to receive certification as a Covered California agent.

Here are some other considerations for selling in California:

  • California permanently adopted an extended open enrollment schedule, running from November 1, 2021 through January 31, 2022.
  • California offers both PPO and HMO plans.
  • Children are granted dental benefits under health plans at no extra cost. Additionally, children under 19 can be added to family dental plans to get coverage of services like fillings and crowns.

Selling individual coverage through ACA-funded exchanges presents some unique challenges, but it can be worth the learning curve to reach otherwise underserved markets and receive the 10% premium per member commission. You can also take pride in knowing that you’re helping those without employer-based coverage gain the security that comes from having dental coverage. If you haven’t already, visit the Delta Dental Health Care Exchange page for brokers to get appointed and learn more.