Louisiana uses the federally facilitated health insurance Marketplace HealthCare.gov for the sale of certified individual/family dental plans.
Not all insurers who offer medical plans through the Louisiana exchange include dental coverage with their health plans, but stand-alone dental plans are available for purchase that cover both adults and children.
For adults who purchase their own stand-alone dental coverage through the exchange in Louisiana, premiums in May 2024 ranged from about $10 to $44 per month. 1
If a family is purchasing coverage through the health insurance exchange, the premiums associated with pediatric dental coverage may or may not be offset by premium tax credits (premium subsidies). Here’s more about how that works, depending on whether the health plan has integrated pediatric dental benefits.
In 2024, Louisiana enacted legislation designed to improve transparency around how dental insurers are spending the premiums they collect from enrollees, and how much of the premium revenue is being used to pay for dental care. 2 Starting in 2025, the new law will require dental plans to file dental loss ratio reports with the state insurance commissioner, who will then make the reports publicly available. This will allow consumers to see what percentage of their dental premiums are being spent on dental care as opposed to administrative costs.
(Under federal rules, commercial major medical health plans must comply with minimum loss ratio rules. But there are no federal loss ratio requirements or reporting rules for dental plans.)
The exchange-certified pediatric stand-alone dental plans available in Louisiana will comply with the ACA’s pediatric dental coverage rules.
So out-of-pocket costs for pediatric dental care on a stand-alone plan obtained via the Louisiana Marketplace will not exceed $400 per child in 2024 (or $800 for all the children on a family’s plan), 3 and they don’t have a cap on medically necessary pediatric dental benefits. (For 2025, the out-of-pocket maximums will increase to $425 and $850, respectively. 4 )
If a medical plan has embedded pediatric dental benefits, the maximum out-of-pocket limits described above are not applicable. However, there will be no limit on how much the plan will pay for pediatric dental care, since it’s an essential health benefit.
As is the case for all essential health benefits, the specific coverage requirements for pediatric dental care (either embedded in an ACA-compliant individual market plan, or sold via the Marketplace as a stand-alone dental plan) are guided by the state’s essential health benefits benchmark plan.
You can see details here for Louisiana’s benchmark plan, which does include coverage for both basic and major dental services for children.
In 2024, seven insurers offer stand-alone individual/family dental coverage through the health insurance marketplace in Louisiana. These are dental plans that are not included with a medical plan and must be purchased separately.
These plans can be purchased through HealthCare.gov during open enrollment (November 1 to January 15) or during a special enrollment period triggered by a qualifying life event. Exchange-certified stand-alone dental plans are compliant with the ACA’s rules for pediatric dental coverage.
There are also a variety of dental insurers that sell stand-alone dental plans directly to consumers in the Pelican State. These plans are not subject to the ACA’s essential health benefit rules for pediatric dental coverage, but they are regulated by the Louisiana Department of Insurance. If you would like to purchase a non-ACA qualified dental plan, ask a dentist for recommendations or search online.
There are also various dental discount plans available in every state. Dental discount plans are not insurance, but can offer discounted rates at participating dentists. Here’s what you need to know about the differences between dental insurance and dental discount plans.
To find plans in your area, search online for dental discount plans and the state you are looking to buy a plan in.
Louisiana adults enrolled in Medicaid are eligible for some dental services, such as diagnostic exams and dentures. Eligible children in Louisiana can receive even more robust dental benefits, including a wide array of preventive and therapeutic services.
LaCHIP, which is Louisiana’s CHIP, provides coverage to uninsured children and pregnant women with income above the eligibility limits for Medicaid.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org.
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