New York state continues to seek improvements to adult dental benefits for 2026 and beyond
The New York State Department of Health, the New York State Department of Health, and the Department of Financial Services announced today that, effective January 1, 2025, separate independent dental plan waiting periods will be eliminated for most adult dental services. Available for purchase on the Marketplace. This change is the first in a multi-phase effort to improve dental products and improve the dental plan purchasing experience for consumers.
Adrian Harris, director of the New York State Department of Financial Services, said:“New Yorkers deserve immediate access to essential services, and eliminating wait times ensures patients receive the critical dental care they need, when they need it. Our mission is to In line with this, our Department will continue to promote a fair and transparent New York health care system.”
“Access to quality oral health care plays a critical role in overall health, and it is important to help consumers get care as quickly as possible by eliminating wait times.” State Health Officer Dr. James MacDonald said.. “This change will give New Yorkers easy and streamlined access to most dental products through the Marketplace, ultimately improving their health and quality of life.”
Daniel Holohan, executive director of the New York State Department of Health, said:“Eliminating wait times for most dental services will improve the accessibility and quality of dental insurance through the Marketplace, better meet the health needs of all New Yorkers, and reduce health inequities across the state.” This is the first step in our efforts to further reduce this.”
The waiting period for a standalone dental plan is the period of time during which an individual must be continuously enrolled in the plan before being able to access certain services. This change eliminates the waiting period for the majority of marketplace dental plans, but the waiting period for orthodontic services remains in effect, although it is capped at 12 months.
The New York State Department of Health and Financial Services worked with stakeholders to gather feedback and explore options to enhance access to dental care through the New York State Health Marketplace. The provinces plan to establish standard dental plans to further improve the quality of affordable options available to consumers. Eliminating waiting periods was chosen as the first step toward the long-term goal of improving adult dental products. This is because it can be implemented seamlessly and quickly, while providing additional consumer protections for New Yorkers. New York State Health will continue to work with the Department of Financial Services and stakeholders to understand and address additional concerns as this work continues.
Dental insurance is available for adults and families through certain qualified qualified health plans (QHPs) or stand-alone dental plans in individual marketplaces. Although the majority of QHP plans with integrated dentistry do not have a waiting period, this new requirement does not currently apply to the QHP market. Additionally, all plans offered through the Marketplace include complimentary preventive care such as regular visits and recommended tests, as well as comprehensive coverage that includes doctor visits, hospitalizations, emergency care, and other key medical services. We offer a comprehensive benefits package.
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