New York: Health Dept, NYSoH & DIFS announce improvements to standalone dental plans

New York State of Health

via NY State of Health:

Effective January 1, 2025, Waiting Periods Will No Longer Be Permitted for the Majority of Adult Dental Services Offered Through the Marketplace

  • New York State Continues to Explore Improvements to Adult Dental Benefits for 2026 and Beyond

ALBANY, N.Y. (April 4, 2024) – The New York State Department of Health, NY State of Health, and the Department of Financial Services announced today that, effective January 1, 2025, there will no longer be waiting periods for the majority of adult dental services for Individual Stand-Alone Dental Plans available to purchase on the Marketplace. This change is the first of a multi-phased initiative to improve dental products and to improve the dental plan shopping experience for consumers. 

“Access to quality oral health care plays a crucial role in overall health, so it is critical that we help consumers receive access to care as quickly as possible by removing waiting periods,” State Health Commissioner Dr. James McDonald said. “This change will make for an easier and more streamlined way for New Yorkers to access most dental products through the Marketplace, and ultimately improve their health and quality of life.”

New York State Department of Financial Services Superintendent Adrienne Harris said, “New Yorkers deserve readily available access to essential services, and eliminating waiting periods will allow patients to get critical dental care they need when they need it. Aligned with our mission, the Department will continue to foster a healthcare system in New York that is equitable and transparent.”

NY State of Health Executive Director Danielle Holahan said, “Eliminating waiting periods for most dental services is the first step in our initiative to improve the accessibility and quality of dental coverage through the Marketplace, to better meet the health needs of all New Yorkers, and further diminish systemic health inequities in the state.”

A waiting period for a stand-alone dental plan is the length of time individuals must be continually enrolled in the plan before they can access certain services.  While this change will eliminate waiting periods for a majority of Marketplace dental plans, waiting periods are still in effect for orthodontic services, but are capped at 12 months.

NY State of Health and the Department of Financial Services have partnered with stakeholders to gather feedback and review options to enhance access to dental care through the NY State of Health Marketplace. The Departments plan to establish standard dental plans to further enhance the quality of affordable options available to consumers. The elimination of waiting periods was chosen as the first step towards the long-term goal of improving adult dental products, as it can be implemented seamlessly and quickly, while at the same time providing New Yorkers with added consumer protections.  NY State of Health will continue to work with the Department of Financial Services and stakeholders to understand and address additional concerns as this work continues. 

Dental coverage is available for adults and families in certain Qualified Heath Plans (QHP) or through a stand-alone dental plan on the individual Marketplace.  While the majority of QHP plans that have dental embedded do not have a waiting period, this new requirement does not currently apply to the QHP market. Additionally, all plans offered through the Marketplace provide a comprehensive benefit package, including free preventive care, such as routine office visits and recommended screenings, as well as doctor’s visits, hospital stays, emergency care, and other key health services.