Dental Coverage for Families in Clay County
Clay County in southeastern Illinois is a small agricultural community centered on Louisville — oil production and farming are the primary industries, and many residents buy dental coverage on their own.
For a family, the rules differ for the kids and the parents. Adult dental care isn’t an essential health benefit under the ACA, so a health plan in Illinois doesn’t have to include it. Whatever health plan you pick through Get Covered Illinois, adult dental coverage is a separate decision in Clay County.
What Family Dental Plans Cover in Clay County
Under a family dental plan, each person’s claims count against their own deductible until the family cap is reached ($50 per person and $150 per family on SecureDental PLUS), and preventive care generally skips the deductible.
If braces are likely, read the orthodontia terms first: plenty of dental plans leave them out, and SecureDental PLUS limits them to the Premium tier, paying 70% after 12 months up to $500 a year and $1,500 over a lifetime.
Enrolling Your Family in Dental Coverage in Illinois
Get Covered Illinois, the state-run exchange in Illinois, sells dental plans alongside its health plans during enrollment periods, and its rules decide whether dental can be added on its own. A stand-alone dental plan bought outside the Marketplace can start in any month, usually on the first of the following month. Put your ZIP code in the form below and Daniel will pull the dental plans sold at that address.
Check waiting periods before you buy. HealthCare.gov notes that separate dental plans can have waiting periods before they cover services for adults; on SecureDental PLUS, basic care waits 1 month and major care and orthodontia 12 months, while cleanings have no wait.
Know where the line sits: a dental plan covers care in a dentist’s chair, while an emergency department visit for a dental abscess or a jaw injury is a health insurance claim. The only hospital with emergency services that Medicare lists in Clay County is Clay County Hospital, so check that your health plan includes it. One of the county’s hospitals is a critical access hospital, the small rural facilities Medicare designates to keep emergency care close.
A stand-alone dental plan is an excepted benefit: it isn’t minimum essential coverage and doesn’t replace health insurance.
Call (713) 575-9904 and Daniel will price the dental plans available at your Clay County ZIP code and check the network for your family.