Policy Alert! CMS Publishes Final Rule to Allow States to Select Adult Dental Coverage as an Essential Health Benefit

The Centers for Medicare & Medicaid Services (CMS) released the 2025 Notice of Benefit and Payment Parameters final rule, designed to enhance accessibility and reliability within the Affordable Care Act (ACA) Marketplaces. In Pennsylvania, we use Pennie (pennie.com).

One significant aspect of the new policies is the expansion of access to health care services, particularly the inclusion of adult routine dental care as a state option. Effective January 1, 2027, states can include adult routine dental services as an essential health benefit (EHB) within their plans offered through the marketplaces. However, states can begin the EHB benchmark application process on January 1, 2025.

See the final rule here (pages 40-43).