Mike Adelberg headshotAllow the Independent Purchase of Qualified Dental Plans on

By Mike Adelberg, NADP Executive Director

February 28, 2024

One of healthcare’s good news stories in recent years is growing enrollment in the health insurance exchanges (“marketplaces”) established by the Affordable Care Act (ACA). Enrollment now tops 21 million. While there is plenty of opportunity to argue about aspects of the ACA, we can all take satisfaction that millions of working families now have affordable medical insurance from a stable set of plans. Less robust is the enrollment in Stand-Alone Dental Plans in the ACA marketplaces. Despite participation from a stable set of reputable plans, dental plan enrollment is only a little more than three million.

The Kaiser Family Foundation estimates that 25.6 million Americans (at the end of 2022) lacked medical insurance. NADP estimates that 288 out of 332 million Americans had dental coverage at roughly the same point in time. So, roughly 46 million Americans lacked dental coverage in 2022 (nearly twice as many as the 25.6 million who lacked medical coverage). These numbers do not include declines in coverage in 2023 related to Medicaid unwinding. Whatever the exact number is today, it is safe to assume that roughly 20 million fewer Americans have dental coverage than medical. Nearly all 20 million people fall into one of three categories:

  • Employed by small businesses that offer medical coverage (required by the ACA) but do not offer dental coverage (voluntary benefit),
  • Medicare beneficiaries in original Medicare, and
  • Medicaid beneficiaries in states without adult dental coverage.

In addition to those without any dental coverage, about half of the nation’s veterans do not see a dentist each year—often because Veteran Administration (VA) dentists are not conveniently located. This is yet another group of people who could benefit from low-cost dental coverage (often about $30 a month).

It is well understood that good oral health substantially impacts overall health. People with dental coverage are more likely to visit the dentist and seek critical preventive services. Preventive dental care reduces the likelihood of emergency room visits and reduces the harmful symptoms of chronic conditions like diabetes or heart disease. Regular dental care also reduces the need for more expensive dental procedures and costly medical complications, holding down total healthcare costs.

The largest of the health insurance marketplaces,, operated by the federal government, has not kept up with the times in terms of offering dental plans. A limitation in’s original build makes dental plan enrollment dependent on the prior purchase of a medical plan. This prevents the independent purchase of dental coverage—something that is enabled on most state-run marketplaces.

At least 13 State-Based Marketplaces (SBMs) allow for the independent purchase of stand-alone dental plans, including the Marketplaces that have come online in the last few years. State officials have cited the ability to purchase dental-only coverage on the marketplaces as an important tool for improving oral health in their state. Marketplaces allow consumers to comparison shop for dental plans from reputable plans that meet specific standards established by the marketplace. Without this, consumers are deprived of the ability to comparison shop. They may end up with dental coverage that does not meet the marketplace’s standards or no coverage at all.

After a bumpy roll-out a decade ago, has matured into a stable system providing good service to tens of millions of Americans who need medical coverage. The National Association of Dental Plans and several allied organizations believe Americans should have the same opportunity to purchase dental coverage.

The time has come to update, which is supported by $7 million in dental plan user fees each year, with the same functionality available in most state-run marketplaces.  46 million Americans lack dental coverage—the federal government can do more to lower this figure.

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