Dental coverage for children: Medicaid, CHIP, Marketplace plans and braces

It must be available, and you do not have to buy it. HealthCare.gov says dental coverage is an essential health benefit for children 18 and under, so if you are getting health coverage for a child, dental must be available either in a health plan or as a separate dental plan. Compare what each offers.

Yes. States must provide dental benefits for children on Medicaid, and the federal low-cost-care pages describe CHIP as covering dental services for children up to age 19 in families who earn too much for Medicaid. Covered services vary by state, so contact your state program.

Insure Kids Now, at 1-877-543-7669, helps find children's dental care programs by state. You can also ask your state program for a list of participating dentists and pediatric dentists. Call the office first to confirm that it accepts your child's plan and is taking new patients.

Sometimes. Cigna says not all dental plans cover braces and that those that do may limit coverage by age and cap what they pay. UnitedHealthcare says some plans do but most do not, and Ameritas describes a mid-range individual plan with a child orthodontic benefit. Read the schedule of benefits.

It varies. Cigna says some plans cover orthodontic care only up to a certain age, and one MetLife government-program listing mentions coverage for children up to age 19 on its higher-level option. Your plan sets its own limit, and it may differ from the age at which a child would benefit.

A one-time spending limit, according to Ameritas, typically used for orthodontic treatment. When the plan reaches it, it will not cover more of those services for the member's lifetime. Ask the plan what the limit is, and whether it is separate from the annual maximum.

Often, as preventive care. Cigna says preventive care covers fluoride treatments and sealants with age and frequency limits, UnitedHealthcare says fluoride is covered for those under age 16 on some plans, and Ameritas notes children's visits may include space maintainers, fluoride and sealants. Check your plan.

It depends on the plan. Principal says an employer plan can cover dependents to age 26, while Anthem's family plans describe pediatric benefits to age 18, with different ages in Kentucky and Connecticut. Check your plan documents, and ask what happens when a child ages off.

Some do not. Anthem says depending on the plan, family plans may have no annual benefit limits for pediatric-age children, and no waiting periods. Other plans have a maximum. Ask for the schedule of benefits, and check how the limit applies to major work such as crowns and braces.

Ask the pediatric dentist about the options, who provides sedation and how it is billed. Coverage varies, and many plans pay only when it is medically necessary. Ask the plan about the exact codes before treatment. See the guide to dental sedation costs and the pediatric dentist guide.

Ask the orthodontist for a written, itemized estimate that lists the records, the appliance, the visits, retainers and any refinements, and ask the plan what it would pay. Compare estimates from two offices using the same line items. Use the orthodontic payment planner to budget.