Whether you are retiring, newly self-employed, or find yourself between jobs, transitioning off an employer dental plan can be confusing. Being prepared and knowing what your options are can help you make the right decision for you and your family. The good news is you have multiple options, including individual dental plans, COBRA, state health exchanges and Medicaid.
1. Continue your employer-sponsored plan with COBRA
The Consolidated Omnibus Budget Reconciliation Act (COBRA) allows you to temporarily continue your employer-sponsored health insurance coverage when group health coverage would otherwise be lost.1 COBRA can be a good short-term coverage option to keep your existing dental coverage immediately after leaving a job with group dental coverage. COBRA can maintain your existing coverage for up to 18 to 36 months after you leave your job.2 If you have a disability, you may be able to qualify for an extended continuation if you provide proof of disability. If you don’t have a disability, your COBRA coverage could run out sooner. If you plan to enroll in insurance through a government exchange, you have 60 days from when you leave your employer plan to do so.
COBRA coverage is often more expensive because you may have to pay the full premium plus up to 2% for administrative costs unless your employer offers to pay for some or all of the premium for a period of time. Enrolling in COBRA coverage after leaving your job can give some time to determine what type of dental coverage will work best for you long term.
2. Enroll in individual dental insurance
Purchase individual dental insurance directly
Individual dental insurance is a type of dental insurance you can purchase on your own or for your family from a dental insurance company online, over the phone, or through a broker.
There are two main types of individual dental plans you can purchase: a Dental Health Maintenance Organization Plan (DHMO) or a Dental Preferred Provider Organization Plan (DPPO). Unlike employer-sponsored plans, individual dental insurance allows you to compare plans before choosing the one that makes the most sense for your needs and budget.
Find a plan on your state’s health insurance marketplace
You can also buy dental insurance on one of the state health insurance exchanges that were created as part of the Affordable Care Act. You can find state marketplace plans during the annual open enrollment period, which usually takes place between November and December in most states, or you may qualify to enroll during the Special Enrollment Period. The Special Enrollment Period for the Marketplace is open to those who are losing employer-based coverage. You’ll have 60 days to enroll in a health plan, even outside of the annual open enrollment period.
3. Select a dental discount plan
Dental discount plans are not insurance. You pay an annual fee to join the discount plan and you also pay the dentist directly the entire cost of services provided by the dentist at a discounted rate negotiated between the dentist who participates in the discount plan and the referring company.3 There are key differences between how dental insurance and dental discount plans treat preventive care, dental procedures, access to dentists, costs, waiting periods, annual maximums and savings bundles that you will need to consider as part of your options.
4. Find another group plan
If you prefer to be on an employer or other group plan, like 90% of Americans with private dental coverage4, you can try going on your spouse’s insurance plan or finding employment that offers group dental coverage.
5. Apply for Medicaid
If you’re still unemployed after your COBRA insurance runs out, you may meet the requirements for Medicaid. Dental is a required service for Medicaid-eligible individuals under 21. If you’re over 21, state may or may not provide dental services. While most states provide at least emergency dental services for adults, less than half of the states provide comprehensive dental care.5
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Brought to you by The Guardian Life Insurance Company of America (Guardian), New York, NY. Material discussed is meant for general illustration and/or informational purposes only and it is not to be construed as tax, legal, investment or medical advice. It is not dental care advice and should not be substituted for regular consultation with your dentist. If you have any concerns about your dental health, please contact your dentist's office. Guardian Direct plans are underwritten and issued by The Guardian Life Insurance Company of America New York, N.Y. or its subsidiaries. Products are not available in all states.