By Mary Otto
What does recent federal data reveal about how dental benefits are working on federal and state insurance marketplaces so far? In “Dental Benefits in Health Insurance Marketplaces: An Update on Policy Considerations” the National Academy for State Health Policy (NASHP) takes a look.
In one perhaps surprising development, young adults aged 26-34 have turned out to be the group most likely to purchase stand-alone dental coverage on the federally-facilitated marketplace, with 302,000 individuals (20 percent of enrollees).
By comparison, 14 percent of the enrollees, or roughly 100,000 were children aged 0-18, according to the most recent marketplace data reported by the U.S. Department of Health and Human Services.
Are young adults in your state obtaining dental benefits? Are they satisfied with their coverage? Why aren’t more parents in your state purchasing dental coverage for their children?
The federal insurance marketplace established under the Affordable Care Act (ACA) and used by 38 states offers adult dental benefits. Twelve of the 13 state exchanges (including the District of Columbia) offer dental coverage too.
That leaves Washington State as the last remaining place where adults cannot buy dental coverage on their insurance marketplace, but plans are moving forward to change that this year, an official from Washington’s state insurance marketplace recently told Heather Drost of California Healthline.
“The implementation of adult dental coverage in the Washington Health Benefit Exchange will mean that adults in all 50 states and Washington, D.C., will have access to those benefits through the ACA exchanges and dental disparities could be reduced,” Drost writes. The road to adult dental coverage has not always been smooth, Drost observes in her piece entitled “Why Some ACA Exchanges Have Delayed Adult Dental Coverage.”
While pediatric dental benefits are counted among the essential health benefits required by the ACA, adult dental benefits are considered optional under the law. “The law’s flexibility on adult dental coverage means that health insurance exchanges have taken different approaches to adult dental coverage, resulting in disparate coverage options,” Drost writes.
A question to ask in your market: How have officials and consumers in your state weighed their decisions about dental coverage?
Here’s another resource: the American Dental Association’s Health Policy Institute offers its own state-by-state analysis of benefit packages and patterns in the report “More Dental Benefit Options in 2015 Health Insurance Marketplaces.”
The authors identify a number of trends including the following:
- More medical plans in more states include embedded dental benefits, a move intended to provide consumers with more options for dental coverage.
- More family stand-alone dental plans are becoming available, offering adults more ways to obtain dental benefits.
- Obtaining pediatric dental benefits through medical plans remains on average, to be cheaper than purchasing a separate stand-alone dental plan.
How does your state fit into the national picture? Check to see.
Related resource: Check out this blog post in the AHCJ Oral Health section.
