The Massachusetts Health Connector now offers dental plans from the state’s leading dental carriers to suit a
variety of needs. You can buy plans for yourself, your children, or your whole family. You can choose from "high
plans," which have more comprehensive benefits, "low plans" with more basic coverage, or a pediatric-only plan for
children under age 19.
Dental Plans for Individuals and Families
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Individual and Family Dental Plans
WHAT IS COVERED?
All Health Connector dental plans cover:
• Preventive services, such as regular cleanings and
fluoride and sealants for children, and diagnostic
services, such as x-rays
• Basic restorative services, such as regular fillings
Major restorative services, such as crowns and
dentures, are covered for children under the age of
19. For adults, these services are covered if you
purchase one of the high plans, which have more
comprehensive coverage.
OUT-OF-POCKET COSTS
All Health Connector plans cover preventive and
diagnostic services in full. For plans that include basic
and major restorative services, only part of the costs
are covered (this is called co-insurance) up to a yearly
limit. This yearly limit (or maximum annual per-person
benefit) only applies to adults 19 years and over.
There is no yearly limit on the costs that the plans will
cover for children under the age of 19, and you will
not have to pay more than $1,000 a year (this is called
your maximum annual out-of-pocket) for your child’s
dental care if you use an in-network provider.
WHICH DENTISTS CAN I CHOOSE?
You should always check to see which networks your
preferred dental provider is in before you choose a
plan. Some plans have larger networks of dentists,
while others have more limited networks. Most plans
will let you get care from a dental provider who is
outside of their network, but you may have to pay
more out of pocket.
COMPARING AND SHOPPING FOR PLANS
The chart on the next page shows the features and
costs for the "standardized" Health Connector dental
plans. Standardized plans are offered by different
carriers and have different names but they all offer
the same core benefits.
Non-standardized versions of these plans have
different network sizes and deductibles and co-pays.
More information about the different plans is available
at MAhealthconnector.org.
IF YOU NEED HELP
• Visit MAhealthconnector.org. You’ll find
lots of details here, including information in
other languages.
• Call Customer Service at 1-877 MA ENROLL
(1-877-623-6765) or TTY: 1-877-623-7773.
• For in-person help, you can work with a
Navigator or a Certified Application
Counselor. These are people who have been
trained to help you with the application
process. For a list of Navigators or Certified
Application Counselors in your area, visit
MAhealthconnector.org.
Individual and Family Dental Plans
Standardized Dental Plans
PLAN FEATURE/SERVICE FAMILY HIGH
(COMPREHENSIVE
COVERAGE)
FAMILY LOW
(BASIC COVERAGE)
PEDIATRIC ONLY
Plan Year Deductible $50 (individual)
$150 (family)
$50 (individual)
$150 (family)
$50
Deductible applies to: Major & Minor Restorative Major & Minor Restorative Major & Minor Restorative
Maximum yearly per person benefit -
For enrollees 19 yrs. and under
$1,250 $750 N/A
Maximum yearly out-of-pocket -
For enrollees under 19 yrs. only
$350 (1 child)
$700 (2 or more children)
$350 (1 child)
$700 (2 or more children)
$350 (1 child)
Preventive & Diagnostic Co-Insurance
(percentage you pay for the service)
0% in-network
20% out-of-network
0% in-network
20% out-of-network
0% in-network
20% out-of-network
Minor (Basic) Restorative Services Co-
Insurance
(percentage you pay for the service)
25% in-network
45% out-of-network
25% in-network
45% out-of-network
25% in-network
45% out-of-network
Major Restorative Co-Insurance
(percentage you pay for the service)
50% in-network
70% out-of-network
50% in-network
70% out-of-network
No Major Restorative for
enrollees 19 yrs. and under
50% in-network
70% out-of-network
Medically Necessary Orthodontia -
For enrollees under 19 yrs. only
(percentage you pay for the service)
50% in-network
70% out-of-network
50% in-network
70% out-of-network
50% in-network
70% out-of-network
Non-Medically Necessary Orthodontia -
For enrollees under 19 yrs. only
(percentage you pay for the service)
N/A N/A N/A
