Affordable Care Act

5 Things Parents Should Know About Pediatric Dental Benefits

Mom Child Brushing Teeth

It’s an alarming statistic: Children in the United States lose over 51 million school hours each year due to dental pain and illness. In these situations, children struggle to focus on their school work, finding it hard to listen and learn in class.

But it doesn’t have to be this way. Pediatric dental insurance benefits can make it easier for children to receive the dental care they need. There are many choices for pediatric dental benefits. Here are five important things parents and caregivers should know.



  1. Dental problems can lead to chronic health issues. The Centers for Disease Control and Prevention says 60 percent of children in the U.S. will have cavities by age 5. Medical professionals report that children in this group are more likely to have ear and sinus infections, and are at increased risk of developing other chronic medical problems, such as obesity, diabetes and heart disease.
  2. Stand-alone dental plans meet families’ needs. These dental benefit plans can be purchased separate from medical insurance, and they offer comprehensive coverage for children and adults. This means the benefits cover everything from preventive care to more complex dental services, such as crowns or root canals.
  3. Dental benefit experts offer standalone coverage. Typically, stand-alone benefits are offered by insurance companies that primarily focus on dental coverage. Since they are dedicated to providing dental benefits, they develop an expertise in this coverage.
    This means that:
  • Benefit coverage can be tailored to meet the needs of employees and employers.
  • Annual premium costs are accurate, so you avoid surprises.
  • Claims processing and customer service are customized to support dental coverage.
  • A network of dental providers located across the country may be available for plan members.
  1. Dental within a medical plan may not provide the benefits families need. When considering a medical plan with dental coverage embedded, it’s important to know how the plan is designed, the insurance company’s experience with dental benefits and the process for paying claims.
  • Coverage rules – The medical plan may cover preventive care for cleanings and checkups, but feature a high deductible that must be met in full before medical or other dental services will be covered. Families with dental needs, such as fillings, crowns or root canals, may face unexpected bills.
  • Orthodontia – Dental coverage within a medical plan may cover only medically necessary orthodontia, such as cleft-lip conditions. Children enrolled in an orthodontia plan to repair crooked teeth and bite problems may no longer have coverage.
  • Dental claims processing – Medical plans with dental coverage may have limited administrative systems that aren’t designed to handle the unique requirements of dental claims, which could slow down the payment process.
  • Expertise – Many medical insurance companies offering dental don’t have the expertise to price dental coverage accurately, and they struggle to set a predictable premium that you can rely on for budgeting.
  1. You have a choice. Medical insurance companies may tell parents and caregivers that they must purchase pediatric dental benefits as part of their medical insurance. But in most states, stand-alone dental plans can be purchased separate from medical insurance.

To learn more about pediatric dental benefits.