5 Tips for Finding Supplemental Coverage for ACA Plans

Although Affordable Care Act (ACA) plans offer coverage for 10 essential health benefits, these plans don’t protect against every health concern. Your clients may greatly benefit from supplemental insurance, or complementary coverage, particularly dental, vision, hearing, hospital indemnity, or accident plans.

Below, we’ll give you five tips on how to find the right ancillary coverage for your clients who would like to maximize their protection and shield themselves from higher out-of-pocket costs.

Why Pair Supplemental Insurance with an ACA Plan?

Supplemental insurance plans often allow people of any age to better manage their health care costs. Primary forms of health insurance, including ACA plans, don’t cover all costs or services. For example, dental, vision, and hearing benefits are not typically included in ACA plans for adults. Please note that dental benefits will be included as an essential benefit in 2027.

All ACA-compliant health plans fit into one of four metal categories and have a set actuarial value. The actuarial value is the percentage of average costs that the plan will cover. Bronze plans have a 60/40 percent actuarial value, meaning the policy holder is responsible for 40 percent of the cost for covered services. Bronze plans can be an affordable health care option for many families and individuals but will include higher out-of-pocket costs, for deductibles, copays, and coinsurance.

Pairing an individual health plan purchased through the marketplace with a supplemental plan, such as a hospital indemnity policy, is a great way to help your clients limit their out-of-pocket expenses. Adding on a supplemental plan can give clients flexibility and may even be a more affordable, customized option than purchasing an individual health plan in another metal category or at a higher actuarial value.

With the proper coverage and planning, ACA clients can avoid paying for services out of pocket and experience more positive health outcomes.

With the proper coverage and planning, ACA clients can avoid paying for services — like routine dental cleanings, glasses, and hearing exams — out of pocket, or greatly lower their costs, and experience more positive health outcomes. There are additional premiums for these insurance plans, but the cost is much more manageable than paying for health services without coverage.

When individuals have adequate health care coverage, it also reduces the strain on the health care system, particularly in the case of emergencies or accidents. Additionally, out-of-pocket health care spending accounts for 10 percent of the national health care spending, according to Centers for Medicare & Medicaid Services. Programs such as affordable health care and private insurance help to manage these numbers.

More Benefits to Be Included in ACA Plans

As part of the 2025 Marketplace Final Rule, CMS announced additional benefits that will be included in ACA plans, including making dental coverage an essential benefit for adults. Currently, dental benefits are only available to pediatric clients on marketplace plans. Beginning January 1, 2027, all adults will be able to access dental coverage as part of their marketplace coverage.

State exchanges can update their benchmark plans to include routine dental coverage for adults for benefits beginning January 1, 2027. CMS mentioned in the HHS Notice of Benefit and Payment Parameters for 2025 Final Rule that adding dental coverage as a benefit allows states to improve the overall health of individuals and limit health care disparities.

In the meantime, we suggest adding supplementary options to your portfolio to address the needs of your ACA clients that may need benefits such as dental, vision, hearing, or hospital indemnity coverage. Check with your state’s marketplace to see if dental benefits are available with any carriers. And if dental benefits are not common, have options available for your clients! Meeting the needs of your clients is the best way to develop good relationships for years to come.

Tips for Helping Under-65 Clients Find Supplemental Insurance

Here’s our advice for finding the right coverage to supplement your clients’ marketplace plan.

1. Review Your Client’s Current Coverage

Evaluate your client’s current marketplace plan. Do they have needs that aren’t being met? It’s important to consider what coverage is or is not included in your clients’ marketplace plans. Plans typically do not include dental, vision, or hearing benefits for adults. In this case, it may be more affordable to select a stand-alone plan for the specific coverage your client will utilize more often.

Perhaps your client wears glasses and makes frequent visits to the eye doctor every year. A dental, vision, and hearing or stand-alone vision plan would be great for this client. A conversation about supplemental coverage could begin with talking about their current glasses and vision needs.

Another flexible option to consider pairing with an individual health plan is accident insurance. With the maximum allowable out-of-pocket limit for ACA compliant plans sitting at $9,200 in 2025, it is becoming increasingly more difficult for individuals and families to depend on their primary health plan to cover all their needs.

Accident insurance provides specific cash benefits for injuries caused by a covered accident, and these benefits are paid directly to the beneficiary and can be used for resulting expenses, such as costs not covered under the primary health plan. This type of policy can be a good fit for individuals and families with an active lifestyle or families with small children, and typically, does not require a client to pass health underwriting.

Still unsure of where to start? Watch our Knight School module on cross-selling to learn the ins and outs of finding the right supplemental coverage for your client.

2. Evaluate Your Clients’ Health

Supplemental insurance plans may require clients to be evaluated for pre-existing conditions. Consider if their health status affects their ability to be approved for an additional plan. If your clients have pre-existing conditions, such as cancer, diabetes, and smoking or other health conditions that may cause them to be denied coverage, make sure you educate them on this risk before applying.

3. Cover the Whole Family

Family plans are also available for supplemental coverage options. Dental and vision benefits are included in ACA plans for children under 18 but are not typically included in plans for adults. If one of your clients has a child that has hearing concerns and uses hearing aids or cochlear implants, a supplemental hearing plan may be of benefit to them. When evaluating concerns, make sure to consider the needs of the whole family, including those of the children.

4. Budget for Added Health Costs

Budget concerns are also relevant when it comes to supplemental coverage options. Most clients will be able to find an affordable plan that covers all three main concerns: dental, vision, and hearing. Clients who are new to the marketplace, but previously had insurance offered by an employer that may have covered dental, vision, and hearing services, may be surprised by the additional costs to achieve the amount of coverage they desire. When evaluating clients’ budgets, make sure they are prepared for additional deductibles and premiums. Supplemental plans have a deductible and allowances for exams and other services to reduce out-of-pocket spending.

Most clients will be able to find an affordable plan that covers all three main concerns: dental, vision, and hearing.

When working with a family, make sure you consider how many family members need coverage when accounting for costs. Deductibles differ for individual versus family coverage, depending on which plan is chosen.

5. Inform Clients of Their Options Ahead of the OEP

Before the Open Enrollment Period (OEP), evaluate all options with your clients. Consider the variables and values that are relevant to the type of plan your client has (if they’re renewing) or is likely choosing (if they’re switching plans or enrolling for the first time). There are multiple carriers that have dental, vision, and hearing and accident insurance plans available. Look over all the options and inform your clients of the best choice for them.

There are dental insurance plans available through the exchange, but these plans can only be sold at the same time as a health plan with a qualifying enrollment period such as the annual OEP. Being aware of your clients’ options before the OEP is an excellent way to be prepared for the unexpected.

One added benefit of selling stand-alone dental, vision, and hearing plans is that they can be sold year-round! This can be a great opportunity to generate new business outside of OEP.

Ritter Is Here to Support You

Navigating these scenarios and considerations can be difficult. That’s why we’ve assembled a team of trusted sales specialists at Ritter Insurance Marketing who have extensive knowledge on marketplace and under-65 health plans and ancillary coverage. Our sales specialists are available to help you answer the tough questions and solve issues that may come up along the way, as well as to review your portfolio and make recommendations.

Supplemental plans are an excellent way to protect your ACA clients from high out-of-pocket costs and put routine health care services, like dental, vision, and hearing care, within reach. We hope these tips not only help you select the right plans to meet your clients’ needs, but also generate new business opportunities and additional income year-round!

Ritter is prepared with staff and resources to help you achieve your business goals! If you’re not a Ritter agent yet, consider registering today! With your Ritter agent status, you’ll have access to a diverse library of tools, a full library of eBooks and Guides, and an expansive library of contracts to make selling marketplace and supplemental coverage even easier.