Dental Exchange FAQ

What is the Affordable Care Act?

Enacted in March 2010, the federal Patient Protection and Affordable Care Act, commonly referred to as the ACA or "Obamacare," provides the framework, policies, regulations and guidelines for implementation of comprehensive health care reform by the states. The Affordable Care Act will expand access to high-quality affordable insurance and health care.

What is a dental insurance exchange?

Exchanges are organizations that are set up to create a more organized and competitive marketing for buying dental exchange. They will offer a choice of different dental insurance plans, certifying plans that participate and provide information to aid consumers better understand their options. Exchanges are set for individuals and small business (up to 100 employees in NY, up to 50 employees in FL and NJ) to purchase dental insurance for themselves or their employees.

What is the difference between "On-Exchange" versus "Off-Exchange"?

The fundamental difference between an "On-Exchange" and "Off-Exchange" health plans are where the applicant performs his or her enrollment. If the enrollment for the health plan is performed within a government-run marketplace for insurance, it is known as an "On-Exchange" health plan. If the enrollment does not take place within the government-run marketplace for insurance, it is known as an "Off-Exchange" health plan. Both on and off-exchange health plans in the individual and small group markets must satisfy Essential Health Benefits coverage requirements and utilize one of the metal plan designs for medical out-of-pocket costs.

What is the difference between individual versus "SHOP"?

Individual refers to a single person purchasing insurance for themselves and/or their dependents. The SHOP Marketplace (Small Business Health Options Program) refers to Small businesses supplying insurance for their employees. The businesses with fewer than 25 full-time equivalent workers, making less than $50,000 in average annual wages, qualify for tax credits through the shop to help them provide health benefits to employees. Those with 10 or fewer full-time equivalent employees, with average annual wages of less than $10,000, can get the full tax credit of up to 50% of their share of employee premiums.

Who can get a dental plan with Healthplex through the Marketplace?

  • Individuals and small businesses with 100 or fewer employees in NY or with 50 or fewer employees in Florida and New Jersey.
  • Must be a US citizen, national, or lawfully present immigrant (Different immigration rules may apply if you are eligible for Child Health Plus or NYS Medicaid based on your income)
  • Cannot be currently incarcerated

Can I buy insurance through the Marketplace if I already have a serious health problem?

Yes. The amount you pay for a health plan will not be affected by your health status. This means that you cannot be charged more because of your health problem.

What if I choose to go without dental insurance coverage?

Adults over age 19 are not required by law to have dental insurance coverage. Any child below age 19 is required by law to have dental insurance coverage.

What if I cannot afford to buy insurance?

Certain people may qualify for a tax subsidy from the federal mandate to have health insurance. If you are approved for a tax subsidy, you will not have to pay a penalty to the Internal Revenue Service for not having health insurance. You can find out information about Exemptions in the Marketplace visit (https://www.healthcare.gov/fees-exemptions/apply-for-exemption/

What is a Subsidy?

The Affordable Care Act (ACA) creates a subsidy system for low and some middle income families to help purchase insurance on the state insurance exchanges, also called "The Marketplace". Beginning January 1, 2014, all Americans will be required to enroll in a healthcare plan that maintains minimum essential coverage or pay a penalty (legally defined as a tax given the Supreme Court's ruling). To offset some of these costs, the ACA provides tax subsidies called the Premium Assistance Subsidy and Cost-sharing Subsidy, to qualifying individuals and families at or below 400% of the federal poverty level (FPL). It also extends Medicaid coverage to individuals and families at or below 138% of the FPL, up from 100%

What dental insurance plans does Healthplex offer?

  • Pediatric plans
  • Adult plans for individuals and families
  • Small Business (SHOP) plans for adults and families
  • All plans are exclusively offered on and off-exchange in Florida, New Jersey and New York states

What is the Federal Poverty Line Level for the state I live in?

Florida consumers for additional information please visit http://www.medicaid.gov/medicaid-chip-program-information/by-state/florida.html

New Jersey consumers for additional information please visit http://www.medicaid.gov/medicaid-chip-program-information/by-state/new-jersey.html

New York consumers for more information please visit http://www.medicaid.gov/medicaid-chip-program-information/by-state/new-york.html

Where can I get help understanding dental insurance terms?

Please visit our dental insurance glossary page for more information. It contains many common dental terms that are helpful to know.

How can I find out how my dental plan affects my tax return?

Members looking for additional information how their dental plan affects their tax return please visit https://www.healthcare.gov/taxes/how-coverage-affects-taxes/