Dental Insurance When You're Self-Employed: How It Works With Marketplace Health Plans

Why dental feels confusing when you leave a job

When you had a job with benefits, dental usually came as its own little card in the same packet as your health plan. You checked a box and moved on. Once you're on your own, nobody hands you that packet. So a lot of self-employed folks ask me whether dental is even part of health insurance.

Sometimes it is and sometimes it isn't. It depends on the plan you choose.

Option one: a health plan with dental built in

HealthCare.gov says some Marketplace health plans include dental coverage. You can see which ones do when you compare plans side by side. With these, one premium covers both your health and dental benefits.

One thing to know before you pick this route. HealthCare.gov says you can't remove dental from a health plan that includes it. If you want to change that later, you'd switch health plans during Open Enrollment or during a Special Enrollment Period.

Option two: a separate dental plan

If your health plan doesn't include dental, you can often add a separate dental plan while you shop. You'll pay a separate premium on top of your health plan premium.

The upside is flexibility. HealthCare.gov says you can cancel a separate dental plan any time and keep your health plan.

Watch for waiting periods

This is the part I'd circle in red. HealthCare.gov warns that separate dental plans can have waiting periods before they cover certain services for adults. During a waiting period you still pay the monthly premium, but the plan won't pay for those services yet.

So if you already know you need a crown or other big work, ask the insurance company about waiting periods before you enroll. That one question can save you a frustrating surprise.

Adults and kids are treated differently

Dental coverage for children 18 and under is an essential health benefit. HealthCare.gov says that means dental coverage must be available for your child, either inside a health plan or as a separate dental plan. You don't have to buy it, but it has to be offered.

For adults it's a different story. Dental isn't an essential health benefit for adults, and health plans don't have to offer adult dental coverage. That's why it pays to check the details for each person in your household.

How I'd approach it for your family

Start with your teeth, not the plan. Think about whether anyone in the family has dental work coming up, and whether your kids need regular checkups. Then look at which health plans include dental and which separate dental plans are offered where you live.

Timing matters too. Marketplace Open Enrollment runs November 1 through January 15, and I put the Open Enrollment dates for self-employed people in one place. If you're also deciding between plan types, my post on HMO vs PPO in plain words covers how networks work, and dental plans have networks too.