Dental coverage and benefits

See how the ADA is pursuing insurance and benefits reforms that improve how dental care is financed and administered for all.
Current policies

View the ADA's official policies on third-party coverage and benefits for dental care.

Current Policies

Health care reform

Whether debating the Affordable Care Act (ACA) or the myriad of other laws that have shaped America's healthcare system, one thing is certain: The ADA is pursuing better insurance reforms to help prevent oral disease before it starts and reduce the number of adults and children with untreated dental disease.

In Congress

July 20, 2021—Comments (PDF) responding to a Senate Committee on Health, Education, Labor, and Pensions request for information on design consideration for legislation to develop a public health insurance option. 

January 14, 2021—Letter (PDF) to the Senate Finance Committee supporting the nomination of Xavier Becerra as Secretary of Health and Human Services.

Health insurance marketplace and state exchanges

The ADA is working with lawmakers, regulators, and others to ensure the dental plans (and benefits) in the health insurance marketplace are fair, affordable, easy to use, and of the highest quality possible. This includes addressing regulatory proposals that would affect the way dental benefits are defined, offered, and administered under the Affordable Care Act (ACA).

Federal agencies

July 28, 2021—Coalition comments (PDF) on the CMS Notice of Benefits and Payment Parameters for FY 2022.

December 20, 2020—Joint comments (PDF) on the CMS Notice of Benefits and Payment Parameters for FY 2022.

February 28, 2020—Coalition comments (PDF) on a CMS proposed rule on the Affordable Care Act benefit and payment parameters for 2021.

June 28. 2019 —Coalition comments (PDF) expressing concerns about the CMS request for information on the Section 1332 State Relief and Empowerment Waivers, which could allow states to weaken the Affordable Care Act's Essential Health Benefits, especially the oral health benefit for children.

February 19, 2019—Coalition comments (PDF) on a CMS proposed rule on the Affordable Care Act benefit and payment parameters for 2020.

Safety net programs

Mending America's tattered dental safety net requires having an adequate (and sufficiently funded) dental workforce—located where it is needed and with the necessary facilities and equipment to carry out its mission. That is why the ADA is working with lawmakers, public health leaders, and others to protect a number of longstanding programs that provide essential dental care and dental-related services to our most vulnerable citizens.

The ADA is also working with state dental societies, state governments, higher education leaders, charitable organizations, and the private sector to bring Community Dental Health Coordinators (CDHCs) to dentally underserved communities throughout the country.

In Congress

October 20, 2021—Coalition letter (PDF) urging members of the House Energy and Commerce Committee to support H.R. 4555, the Oral Health Literacy and Awareness Act.

July 21, 2021—Letter (PDF) thanking Rep. Anthony Brown for introducing H.R. 4510, the Health Enterprise Zones Act, which aims to attract dentists to underserved communities through tax incentives, grants, and student loan repayment options.

July 7, 2021—Letter (PDF) thanking Rep. Frank Pallone, Jr. for introducing H.R. 3671, the Doctors of Community Act (DOC Act), which would permanently extend and expand the Teaching Health Center Graduate Medical Education (THCGME) program to train residents on serving in community-based settings such as federally qualified health centers, rural health centers, and tribal health centers.

July 6, 2021—Letter (PDF) thanking Sen. Patty Murray for introducing S. 1958, the Doctors of Community Act (DOC Act), which would permanently extend and expand the Teaching Health Center Graduate Medical Education (THCGME) program to train residents on serving in community-based settings such as federally qualified health centers, rural health centers, and tribal health centers.

June 28, 2021—Coalition letter (PDF) thanking Rep. Karen Bass for introducing H.R. 1794, the Foster Youth Dental Act, which would increase Medicaid dental coverage for former foster youth ages 21 to 25.

May 27, 2021—Letter (PDF) thanking Sens. Susan Collins and Jacklyn Rosen for introducing S. 958, the Maximizing Outcomes through Better Investments in Lifesaving Equipment for (MOBILE) Health Care Act (MOBILE Act), which will expand the New Access Point (NAP) grants program to allow for the improvement of mobile oral health centers.

May 27, 2021—Letter (PDF) thanking Rep. Karen Bass for introducing H.R. 1794, the Foster Youth Dental Act, which would increase Medicaid dental coverage from 21 to 25 for former foster youth.

April 14, 2021—Coalition letter (PDF) thanking Rep. Blunt Rochester for introducing H.R. 2295, the HIV Epidemic Loan-Repayment Program Act of 2021 (or HELP Act), which would offer loan repayment up to $250,000 for the HIV dental workforce.

February 26, 2021—Coalition letter (PDF) thanking Rep. Diaz Barragan for sponsoring H.R.379, the Improving Social Determinants of Health Act.

February 5, 2021—Coalition letter (PDF) urging congressional leaders to increase the Medicaid FMAP percentage by at least 5.8%.

Federal agencies

September 16, 2020—Comments (PDF) to the Health Resources and Services Administration (HRSA) on Health Professional Shortage Areas (HPSAs) that express concerns with the current way HPSAs are designated and give suggestions for an alternative methodology.

December 20, 2019—Comments (PDF) on the in response to the request for information about the HRSA PreventionX initiative, including recommendations to increase use of community dental health coordinators.

October 9, 2019—Comments (PDF) in response to the HRSA request for information on rural health care, including dental Health Professional Shortage Areas (HPSAs).

Medicaid and CHIP

The ADA works closely with lawmakers, regulators, and others to help mend the tattered dental safety net. This includes reforming parts of the Medicaid program, which is the largest source of funding for medical and other health-related services for people with low income in the United States. The ADA is also fighting to maintain federal requirements for states to cover dental services in their respective CHIP programs.

In Congress

August 11, 2021—Coalition letter (PDF) urging Sens. Chuck Schumer and Ron Wyden and Reps. Nancy Pelosi and Frank Pallone, Jr., to cosponsor, H.R. 4439, the Medicaid Dental Benefit Act, which would make adult dental services a mandatory coverage category for all adults in Medicaid.

April 27, 2021—Coalition letter (PDF) thanking Sens. Mark Warner and Raphael Warnack for sponsoring S. 245, the States Achieve Medicaid Expansion Act of 2021 (or SAME Act), which would expand Federal matching assistance to states that choose to expand Medicaid coverage to newly eligible individuals.

April 15, 2021—Letter (PDF) thanking Senator Stabenow for introducing S. 560 the Oral Health for Moms Act, which expands dental coverage for women during their pregnancy and postpartum.

March 23, 2021—Coalition letter (PDF) thanking Senators Cardin and Stabenow for introducing S. 448 the Ensuring Kids Have Access to Medically Necessary Dental Care Act, which will eliminate the annual and lifetime dollar limits on dental care provided under CHIP.

March 12, 2021—Coalition letter (PDF) thanking Senators Bob Casey, Catherine Cortez Masto, and Representative Susie Lee for introducing the Coronavirus Medicaid Response Act, which would provide an automatic FMAP increase for State Medicaid programs.

Federal agencies

September 21, 2021—Coalition letter (PDF) urging CMS to revisit the dental community's continuing concerns about beneficiary access to covered facility-based dental surgeries.

July 30, 2021—Coalition letter (PDF) urging CMS to revisit ongoing issues related to coding for hospital-based dental procedures and anesthesia.

July 21, 2021—Coalition letter (PDF) urging CMS to consider several priorities for Medicaid.

July 16, 2021—Letter (PDF) congratulating Daniel Tsai on his appointment as Deputy Administrator and Director of CMCS and looking forward to working with CMCS on a number of areas including Medicaid and health equity.

June 9, 2021—Letter (PDF) congratulating Chiquita Brooks-LaSure on her confirmation as Administrator of the Centers of Medicare and Medicaid Services (CMS), and offering to work with CMS on a number of areas including Medicaid and health equity.

October 2, 2020—Coalition letter (PDF) urging CMS to update the Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System in order to improve patient access to dental procedures in hospitals and surgery centers.

April 17, 2020—Letter (PDF) urging the Department of Health and Human Services to provide Medicaid relief funds for Dentists.

February 5, 2020—Letter (PDF) urging CMS to address several concerns about the impact Medicaid block grants would have on Medicaid dental care

November 6, 2019—Coalition letter expressing concerns about pediatric Medicaid dental audits.

September 13, 2019—Coalition letter (PDF) commenting on the CMS proposal to rescind the Medicaid access rule.

September 13, 2019—Coalition letter (PDF) commenting on the CMS proposal to rescind the Medicaid access rule.

January 11, 2019—Coalition letter (PDF) commenting on the CMS proposed rule on Medicaid and Children's Health Insurance Program (CHIP) Managed Care.

May 22, 2018—Coalition letter (PDF) urging CMS to reconsider proposed changes to the Medicaid access rule.

Non-covered services

The ADA is working to prevent dental insurers from interfering when a contract dentist agrees to furnish a non-plan service to a patient who knows the service is not covered by his or her plan. This includes preventing insurers from arbitrarily changing the terms and conditions of the practitioner's contract without the practitioner's acknowledgement and acceptance of the new terms of service.

In Congress

May 24, 2021—Letter (PDF) supporting S. 1793, the Dentist and Optometric Care Access Act of 2021 (DOC Access Act), which would prohibit private health insurance plans from setting rates for items and services that are outside the scope of what the plans actually cover.

May 24, 2021—Letter (PDF) supporting H.R. 3461, the Dentist and Optometric Care Access Act of 2021 (DOC Access Act), which would prohibit private health insurance plans from setting rates for items and services that are outside the scope of what the plans actually cover.