Proposed rule change aims at making family dental coverage more affordable

Mary Otto

About Mary Otto

Mary Otto, a Washington, D.C.-based freelancer, is AHCJ's topic leader on oral health and the author of "Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America." She can be reached at mary@healthjournalism.org.

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Photo: Melissa Clark via Flickr

Oral health advocates are applauding a recently proposed federal rule they say would remove a significant financial barrier many parents face when shopping for affordable dental benefits for their children on health insurance marketplaces.

A rule change filed last month by the Internal Revenue Service (IRS) would adjust how premium tax credits are calculated to better ensure the credits can apply to stand-alone pediatric dental coverage purchased on exchanges.

Dental benefits for children were among the 10 “essential healthcare benefits” included in the 2010 Patient Protection and Affordable Care Act (ACA).

But dental benefits usually are sold separately from other health care benefits. The benchmark the IRS has been using to calculate tax credits, which can help eligible families when purchasing coverage under the ACA, does not take into account the additional expense of buying stand-alone dental benefits for children.

Groups ranging from dentists to dental plans, plus oral health advocates have been pressing to change the rule since regulations outlining the tax credits were published in 2012.

In 2013, the American Dental Association, the National Association of Dental Plans, the Delta Dental Plans Association and the Children’s Dental Health Project wrote a joint letter to Treasury Secretary Jack Lew asking for a reconsideration. In part, it said:

Oral health is critical to children’s overall well-being. Congress recognized as much when it included oral care for children as one of the essential health benefits specified in the ACA. Congress also intended that the purchase of the entire essential health benefits package be supported with premium tax credits. … Without premium credits for separate dental policies, many families will be tempted to forego dental coverage for their children. This would be an enormous missed opportunity to provide oral health services to vulnerable children who need them.

Colin Reusch

Colin Reusch

Only about one third of marketplace health plans now include dental benefits for children. In some exchanges, pediatric dental benefits are only sold as stand-alone plans, wrote Colin Reusch, senior policy analyst at the Children’s Dental Health Project, in a recent blog.

The proposed rule change would help make pediatric dental coverage more accessible to families by addressing a longstanding “glitch” in the way the premium tax credits have been calculated.

“Starting in 2019, families purchasing both a health plan that does not include pediatric dental coverage and a stand-alone pediatric dental plan would receive a tax credit amount based upon the premiums of both a benchmark health plan and a benchmark dental plan,” Reusch wrote. “This ensures that all families eligible for premium tax credits get the full amount to which they are entitled, regardless of how they purchase their children’s dental coverage.”

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