Affordable Care Act (ACA) Policies

Helping exchange policyholders understand and access their benefits.

Affordable Care Act (ACA) Policies2025-06-20T13:14:49-04:00

Your Exchange Dental Plan

Navigating your dental coverage through the healthcare exchange should be simple and stress-free. Here, you’ll find answers to common questions about your dental plan, easy access to important tools like finding an in-network dentist or viewing claims, and support options if you need personalized assistance. At Renaissance, we’re committed to helping you make the most of your dental benefits so you can feel confident and cared for every step of the way.

A mother kisses her baby while the father watches with a warm smile and affectionate gaze.

Pediatric Dental Coverage and Essential Health Benefits

Under the Affordable Care Act (ACA), pediatric dental coverage is one of the 10 Essential Health Benefits (EHB). If you have dependents under 19, your dental plan options from Renaissance in select states may include these pediatric dental EHBs. During your renewal, please let us know if you need to add this coverage to your policy.

ACA Policy Frequently Asked Questions

What are Essential Health Benefits (EHB)?2025-06-21T11:55:20-04:00

The ACA mandates that all policies issued in the small group and individual insurance markets provide coverage for certain benefits, which are commonly referred to as Essential Health Benefits (EHBs). Those benefits include the following:

  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care
How does the out-of-pocket maximum work for my EHB-compliant plan?2024-11-06T14:41:00-05:00

Typically, the out-of-pocket maximum is the maximum amount that the individual will pay in a given benefit year for in-network EHB covered services. Out-of-pocket expenses that count towards the out-of-pocket maximum include your deductible, co-pay, and co-insurance. This may vary slightly depending on your state.

Will I have annual or lifetime limits on EHB coverage?2025-05-28T13:53:00-04:00

No, there are no annual or lifetime limits on covered services described as EHB.

How do the tax credits work for individuals? Do they cover dental?2024-11-06T14:35:56-05:00

Individual who are at or below 400% of the poverty level will only receive subsidies (Premium Tax Credits) to help with insurance premiums when they purchase in the Individual Marketplace. They will not receive subsidies if they purchase through their employer. Also, these subsidies will apply to medical coverage first and may not be large enough to cover pediatric dental benefits. Subsidies cannot be used to purchase adult dental benefits. Note that if an employer covers part of the cost of an employee’s benefits, the employee is not eligible for a subsidy through the Individual Marketplace.

Am I really covered if dental is included with my medical benefits?2024-11-06T14:34:00-05:00

Dental benefits may be embedded in a medical plan. However, medical deductibles are often much higher than dental, and non-preventive dental expenses may not be covered until the medical deductible is reached. Even if benefits are embedded, you may want to check your options with a supplemental individual dental plan.

Are the adult and pediatric benefits different under an EHB-compliant plan?2024-11-06T14:32:52-05:00

Adults may have different benefits than their children/dependents who are under age 19 and enrolled in an EHB-compliant plan.

Is orthodontia covered under the EHB-compliant Pediatric Dental Benefit?2024-11-06T14:31:09-05:00

Orthodontia is covered as an EHB in most states. However, it may only be covered to the extent it is “medically necessary.”

Up to what age are EHB-compliant pediatric dental benefits offered?2025-05-28T13:51:36-04:00

Generally, EHB-compliant pediatric dental benefits are provided up to age 19 unless a state selects a higher age.

What other scenarios would NOT require me to purchase an EHB-compliant dental offering?2024-11-06T14:22:18-05:00

To the extent that you have one of the below scenarios or you have purchased medical coverage that meets minimum essential coverage requirements your policy may not need to be EHB compliant.

  • Employer-sponsored coverage (including COBRA coverage and retiree coverage);
  • Medicare Part A coverage and Medicare Advantage;
  • Most Medicaid coverage;
  • Children’s Health Insurance Program (CHIP) coverage; and
  • Certain types of veterans health coverage administered by the Veterans Administration
I have Medicare coverage. Am I required to purchase a dental plan that is certified with Essential Health Benefit requirements?2024-10-31T10:31:21-04:00

If you are 65 or older and have Medicare coverage, you are not required to purchase an EHB-compliant plan for yourself. The ACA will have no impact on your dental plan offering.

Family of four sitting on a dock fishing, including mom, dad, daughter, and son.

A Benefits Experience That Stands Out

At Renaissance, we’re committed to delivering high-quality, accessible dental benefits that support the health and well-being of individuals and families across the nation. With years of experience, we partner with healthcare exchanges to provide comprehensive dental coverage that includes preventive, restorative, and essential health benefits like pediatric dental care. Our network of trusted providers and dedicated customer support team work to ensure you can easily access and manage your benefits.

Go to Top