California reverses course on pediatric dental coverage

Photo by courtney0609 via Flickr.

Photo by courtney0609 via Flickr

Last year about this time, we were reading about Covered California’s decision to require parents seeking pediatric dental coverage on the state’s new insurance exchange to buy separate stand-alone plans for their children.

Pediatric dental coverage was designated as one of 10 essential benefits under the Affordable Care Act (ACA). But most dental insurance is sold separately from other kinds of health insurance, and some people supported the idea of selling pediatric dental benefits separately on the state exchange. They contended that consumers who did not want or need pediatric dental benefits should not be required to buy them.

At the same time, Covered California’s plan to offer pediatric dental coverage through stand-alone plans came as a disappointment to oral health advocates. They argued that embedding dental benefits into the health care plans for sale on the state exchange would help expand children’s access to dental care and lower the costs of the benefits by distributing the burden of paying for them across a broader group of people.

State insurance exchange officials promised to revisit the issue. They did. Now it appears that oral health advocates have gotten their wish. In 2015, all individual health insurance plans sold on California’s insurance exchange are expected to include pediatric dental benefits for those younger than 19, Donna Domino reported in

“Exchange officials decided to require pediatric dental coverage in all medical plans after data showed that less than a third of the children enrolled in the exchange also had dental coverage in 2013,” Domino wrote in an Aug. 27 story for the online dental news publication.

Officials indicated that the added cost of dental coverage appeared to be a decisive factor in the low number of enrollees, she noted in the article.

Colin Reusch, policy analyst at the Children’s Dental Health Project, applauded the new approach. “Including pediatric dental in all the health plans ensures that every child and adolescent enrolling in coverage through Covered California has a comprehensive dental benefit,” he told “In addition, it guarantees that qualifying families receive a tax credit based on the full cost of their coverage, which often isn’t the case when children’s dental coverage is purchased separately,” Reusch added. He also praised Covered California’s decision to structure the plan so that while pediatric dental coverage is embedded, dental services are not subject to the medical deductible.

“This decision makes necessary oral healthcare much more accessible for children without breaking the bank for families, and places California alongside Connecticut as a model for how to integrate children’s dental benefits into marketplace coverage,” Reusch told

Adult dental services are not included in the ACA’s list of essential health benefits. But a new study from the American Dental Association’s Health Policy Institute has found that young adults, aged 26 to 34 are, by a wide margin, the most likely age group to buy stand-alone dental benefits on state exchanges.

Researchers calculated the number of individuals of different age groups that selected a medical plan and a stand-alone dental plan using data from the 36 states currently offering coverage through the Federally Facilitated Marketplace as well as from California.

They found that 26.7 percent of the young adults selecting a medical plan had also selected a dental plan, with rates steadily decreasing for older and younger groups.

The take-up rate for children was just 20.1 percent, although the authors cautioned the calculation excluded pediatric benefits obtained through medical plans. Seniors showed the lowest rates of all, with only 10.8 percent selecting a stand-alone dental plan along with their medical plan.

Still, the news that young adults are buying dental benefits on the exchanges can be seen as an encouraging sign for oral health, the authors noted. “Young adults are the most likely of any age group to face financial barriers to dental care,” they wrote. “Their dental care use has declined over time and they account for most of the increase in emergency room visits for dental conditions.”

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  1. Pingback: How are patients dealing with rising costs of dental coverage? | Association of Health Care Journalists

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