Dental Plan Comparison Tool

This tool is designed to help you compare dental plans that are offered through NY State of Health.

If you plan to enroll only your children in dental benefits, select the Pediatric Dental tab below.

If only adults or both adults and children need dental coverage, you can either shop for stand-alone family dental plans (select the Family Dental tab below) or you can see if there are Qualified Health Plans that include a family dental benefit in your county (select the QHP with Dental tab below).

Next, select the County in which you reside. Then, enter the number of children you wish to enroll in a Pediatric Dental plan OR who you wish to enroll in a Family Dental plan or in a QHP with family dental benefits. (Please note – only policies that indicate “Family Dental” would include dental benefits for adults).

Make sure to hover over the “Question Marks” for help.

Issuer Name Plan Name New for 2021 Plan Type Coverage Level Dep Age Referrals Required to See a Specialist Specialists Requiring Referrals Annual Benefit Maximum Lifetime Benefit Maximum Waiting Periods Out of Network Coverage? County Premium Brochure Deductible Adult Individual MOOP Adult Individual Deductible 2+ Members - Adult MOOP 2+ Members - Adult Office Visit With No Additional Services - Adult Oral Evaluation - Adult Complete Set of X-Rays - Adult Cleanings - Adult Topical Fluoride - Adult Polishing - Adult Sealant (per tooth) - Adult Simple Extraction - Adult Fillings - Adult Single Restoration Crowns - Adult Pulp Cap - Adult Root Canal - Adult Scaling - Adult Planing - Adult Gingivectomy or Gingivoplasty - Adult Gum Surgery - Adult Tissue Grafting - Adult Routine Braces - Adult Partial Dentures - Adult Complete Dentures - Adult Dental Implants - Adults Bridges - Adults Veneers - Adult TMJ - Adult Deductible Pediatric Individual MOOP Pediatric Individual Deductible Pediatric 2+ Children MOOP Pediatric 2+ Children Dental Check-Up - Child Basic Dental Care - Child Orthodontia - Children Major Dental Care - Child Deductible Adult Individual MOOP Adult Individual Deductible 2+ Members - Adult MOOP 2+ Members - Adult Office Visit With No Additional Services - Adult Oral Evaluation - Adult Complete Set of X-Rays - Adult Cleanings - Adult Topical Fluoride - Adult Polishing - Adult Sealant (per tooth) - Adult Simple Extraction - Adult Fillings - Adult Single Restoration Crowns - Adult Pulp Cap - Adult Root Canal - Adult Scaling - Adult Planing - Adult Gingivectomy or Gingivoplasty - Adult Gum Surgery - Adult Tissue Grafting - Adult Routine Braces - Adult Partial Dentures - Adult Complete Dentures - Adult Dental Implants - Adults Bridges - Adults Veneers - Adult TMJ - Adult Deductible Pediatric Individual MOOP Pediatric Individual Deductible Pediatric 2+ Children MOOP Pediatric 2+ Children Dental Check-Up - Child Basic Dental Care - Child Orthodontia - Child Major Dental Care - Child Out of Country Coverage Out of Country Coverage Description Out of Service Area Coverage Out of Service Area Coverage Description National Network Network Name Network URL
BlueShield of Northeastern New York Blue Value Dental 1, NS, OON, Blue Marketplace, Dep25 Adult/Family Dental N Individual Age 25 N

Y Albany
$
30.14
$50 None $50 per member up to $150 per family None $0 $0 $0 $0 Not covered $0 Not covered 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Not covered 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Not covered 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Not covered Not covered $0 $350 $0 $700 per group $20 copayment 50% coinsurance 50% coinsurance 50% coinsurance $50 None $50 per member up to $150 per family None $0 $0 $0 $0 Not covered $0 Not covered 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Not covered 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Not covered Not covered $0 $350 $0 $700 per group $20 copayment 50% coinsurance 50% coinsurance 50% coinsurance N N/A Y Pays in-network participating provider allowed amount N Blue Marketplace

BlueShield of Northeastern New York Blue Value Dental 1, NS, OON, Blue Marketplace, Dep29, Adult/Family Dental N Individual Age 29 N

Y Albany
$
30.14
$50 None $50 per member up to $150 per family None $0 $0 $0 $0 Not covered $0 Not covered 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Not covered 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Not covered 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Not covered Not covered $0 $350 $0 $700 per group $20 copayment 50% coinsurance 50% coinsurance 50% coinsurance $50 None $50 per member up to $150 per family None $0 $0 $0 $0 Not covered $0 Not covered 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Not covered 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Not covered Not covered $0 $350 $0 $700 per group $20 copayment 50% coinsurance 50% coinsurance 50% coinsurance N N/A Y Pays in-network participating provider allowed amount N Blue Marketplace

Delta Dental of New York, Inc Delta Dental PPO Basic Plan for Families NS OON Family Dental Dep 25 WP N Individual Age 25 N

Y Albany
$
14.21
$50 None $150 per group None Not covered $0 after deductible $0 after deductible $0 after deductible Not covered $0 after deductible Not covered Not covered 50% after deductible Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered 50% after deductible $65 $350 $195 per group $700 per group $0 after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible $50 None $150 per group None Not covered $0 after deductible $0 after deductible $0 after deductible Not covered $0 after deductible $0 $0 50% after deductible Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered 50% after deductible $65 $350 $195 per group $700 per group 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible N N/A Y National network Y Delta Dental PPO

Empire BlueCross (Dental Upstate) Empire Dental Family Enhanced, NS, OON, Prime, Dep25, Adult/Family Dental, WP N Individual Age 25 N

N Albany
$
18.56
$50 None $50 per member up to $150 per family None Not covered 0% after deductible 0% after deductible 0% after deductible Not covered 0% after deductible Not covered 20% after deductible 20% after deductible 50% after deductible Not covered 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible Not covered 50% after deductible 50% after deductible 50% after deductible 50% after deductible Not covered Not covered $0 $350 $0 $700 $0 20% coinsurance 50% coinsurance 20% coinsurance $50 None $50 per member up to $150 per family None Not covered 50% after deductible 50% after deductible 50% after deductible Not covered 50% after deductible Not covered 50% after deductible 50% after deductible 50% after deductible Not covered 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible 50% after deductible Not covered 50% after deductible 50% after deductible 50% after deductible 50% after deductible Not covered Not covered $0 None $0 None $0 20% coinsurance 50% coinsurance after deductible 20% coinsurance Y Out of Country covered services are reimbursed as out-of-network benefits. Y If a member does not use a network dentist, services will be reimbursed at the out-of-network level. N Dental Prime

Empire BlueCross (Dental Upstate) Empire Dental Family Value, NS, OON, Prime, Dep25, Adult/Family Dental, WP N Individual Age 25 N

Y Albany
$
9.68
$50 None $50 per member up to $150 per family None Not covered 0% after deductible 0% after deductible 0% after deductible Not covered 0% after deductible Not covered 50% after deductible 50% after deductible Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered $25 $350 $25 per person $700 25% coinsurance after deductible 25% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible $50 None $50 per member up to $150 per family None Not covered 50% after deductible 50% after deductible 50% after deductible Not covered 50% after deductible Not covered 50% after deductible 50% after deductible Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered Not covered $25 None $25 per person None 25% coinsurance after deductible 25% coinsurance after deductible 50% coinsurance after deductible 50% coinsurance after deductible Y Out of Country covered services are reimbursed as out-of-network benefits. Y If a member does not use a network dentist, services will be reimbursed at the out-of-network level. N Dental Prime

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