By Mary Otto
As state health insurance marketplaces opened for business this month Marissa Evans of Kaiser Health News offered a nice consumer-friendly Q&A on pediatric dental and vision care under the Affordable Care Act.
The piece appeared in The Washington Post’s Oct. 14 Health and Science section, Obamacare and Kids Dental, Vision Coverage.
The questions and answers started off like this:
Q: “Will I be required to buy pediatric dental care if I purchase insurance on the exchange?
A: “Most likely, no. Children’s dental care may be included in some plans offered on the marketplaces. But many insurers may offer it as a stand-alone policy, which you are not required to buy under federal law, though people in some states are required to do so. Nevada and Washington state, for example, are requiring this coverage…”
Now there is the rub for health care reporters.
When it comes to the new health insurance exchanges, every state has its own pediatric dental benefits story.
In the next five years, an estimated 3 million children are expected to become eligible to receive private dental benefits through the insurance marketplaces set up by the states.
They will be among the approximately 8.7 million children who stand to gain extensive dental coverage through the ACA.
(Another 3.2 million kids are anticipated to get coverage under Medicaid and another 2.5 million through employer-sponsored insurance, according to the American Dental Association. All told, the health care reform law could reduce the number of children without dental benefits by 55 percent, the ADA finds.)
But back to pediatric dental benefits on the exchanges. How is your state coping with the challenges of offering them? And will the benefits result in getting more kids the dental care they need?
Time – and good reporting – will tell.
Under the ACA. pediatric dental benefits are among the 10 essential health benefits that must be included in all plans offered on the exchanges. While federal law does not require the purchase of pediatric dental benefits on the exchanges, states can mandate their purchase.
States have been given latitude in choosing the benchmark standards for carriers participating on their exchanges, so carriers and plans being offered vary from place to place.
This fact sheet from the National Association of Dental Plans, a trade group representing private dental benefit companies, offers some nuts and bolts:
The fact that dental insurance is nearly always sold separately from medical insurance has contributed to additional choices for states.
In integrating dental benefits into the products for sale in their marketplaces, states need to decide whether to embed dental benefits into qualified health plans; offer them as stand-alone plans bundled with medical plans, or offer them as separate stand-alone plans.
These decisions have the potential to get controversial, as Chad Terhune’s reporting for the Los Angeles Times has revealed.
Children’s advocates in California have argued that embedding dental benefits would expand access to the widest number of children while lowering their cost by spreading the burden of paying for them over the largest pool of beneficiaries, Terhune reported. But opponents of embedded dental benefits contended that people who did not need or want pediatric dental benefits should not be required to buy them. And some state officials said that embedding dental benefits into medical plans would make it harder for consumers to comparison shop for coverage. California ultimately opted to offer standalone dental benefits for 2014 but promised to revisit other options in coming years.
Adding to affordability concerns for some parents and legislators is a federal ruling allowing stand-alone pediatric dental plans to charge a maximum of $1,000 per child in out-of-pocket costs over and above the cost of their health plan. Health insurers, however, have supported the separate out-of-pocket thresholds, as John Fritze explained in a Baltimore Sun story, “Advocates, Insurers Duel Over Cost of Child Dental Coverage.”
Beyond all this, there is the question of whether benefits will actually translate into care for children, particularly in areas lacking sufficient providers. While it is true that children with private dental benefits are more likely than those on Medicaid to get care, more than 45 million Americans live in federally-designated dental health provider shortage areas. This report entitled “In Search of Care” produced by the Pew Charitable Trusts takes a look at the problem.
So how is your state exchange handling pediatric dental benefits? Are parents required to buy them? Are they affordable? And will there be dentists out there to see the kids?
