The new health insurance exchanges mandated by the Patient Protection and Affordable Care Act are required to offer pediatric dental benefits.
But what procedures will be covered under the plans being offered in the states?
Will the benefits be affordable?
Will families actually buy them?
Three million children are expected to gain dental coverage through these insurance marketplaces over the next five years, according to the American Dental Association.
But states are still in the process of integrating dental benefits into the coverage that will be offered when their marketplaces open in the fall.
Oral health advocates, who fought hard for the inclusion of pediatric dental benefits under health care reform, are paying close attention to the process.
Each state is required to decide upon a benchmark insurance plan that sets standards for coverage by insurance carriers participating in the state insurance exchange.
The states have latitude in choosing their benchmarks. The benefits being offered will vary. So will the carriers selected, and the details of the plans that will be offered. Then there is the fact that dental insurance is nearly always sold separately from medical insurance.
That gap remains under the ACA and, with it, the worry, at least among some oral health advocates and legislators, that the cost of dental care may remain out of reach for the families who need it most.
Groups including the Children’s Dental Health Project and Community Catalyst are concerned that federal tax credits intended to help qualifying families buy insurance will not be sufficient to cover the cost of stand-alone dental insurance.
Then there are the separate out-of-pocket limits for dental care that can be incurred over and above the limit set for other health benefits. A group of U.S. senators, led by Maryland Democrat Ben Cardin, has objected to a proposal by the Centers of Medicare and Medicaid asserting that a separate out-of-pocket limit of up to $1,000 per child for dental services be considered “reasonable” in the federally facilitated exchanges taking shape in many states.
The answers may take a while to become clear, but now is a good time to try to find out more about what is going on with pediatric dental benefits in your state’s health insurance exchange.
