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Does Obamacare include dental benefits? Watch California for clues

Dec 18, 2012

California and Obamacare

Photo Source: Advanced Continuing Education Systems

No state in the country has been more enthusiastic about adoption of the Affordable Care Act (ACA) than California. 

California lawmakers have wholeheartedly embraced the ACA, commonly known as Obamacare, since it passed March 21, 2010 by a single party vote.  California quickly created its own insurance exchange (California Health Benefit Exchange), developed six “pioneer” accountable care organizations (ACA’s) and shipped millions of Medi-Cal (Medicaid) cards in anticipation of the program’s expansion for low-income residents in January, 2014.

Like any new program however, California is experiencing a few road bumps on the freeway to what is supposed to be affordable health care for everyone, including thorny issues like:

  • DENTAL BENEFITS – ARE THEY INCLUDED OR NOT? The law says all approved insurance must include a set of “essential benefits” and those include “pediatric services, including oral and vision care.” But medical plans and dental plans are often sold separately, and Obamacare doesn’t stipulate if a penalty will be assessed and if so how much it may be if a parent doesn’t get dental coverage for their kids.

  • UNCERTAINTY Federal regulators have said it will be up to the individual states whether or not to offer dental benefits in their insurance exchanges, but as of December 14th the California Health Benefit Exchange had no comment on whether dental insurance would be mandatory and whether failure to carry it would be punishable by a fine.

  • SETTING THE BENEFITS BAR HIGH California has decided to base state dental benefits on its Healthy Families dental program but the benefits of that program are overly generous at best, fiscally unsustainable at worst. For instance, recipients of the program have no copays for preventive care, root canals and diagnostic services, nor major services like crowns and orthodontia.

 But the California Dental Association praises the state’s adoption of the benefits used in the Healthy Families program. “It has a proven track record of meeting the oral health needs of California standards and meets the professional standards of dentists who are taking care of children,” said Dr. Lindsey Robinson, president of the California Dental Association.

  • ARE THERE ENOUGH DENTISTS? Beginning January 2013, all Healthy Families recipients will be swapped to Medi-Cal, and a federal appeals court recently ruled that California can reduce Medi-Cal payments to health care providers by 10 percent. Critics say this will drive current providers out of the program, possibly creating a shortage of healthcare practitioners, including dentists, just when the state is expanding the number of Medi-Cal recipients by three million.

Dr. Robinson has seen those numbers and remains “hopeful” the state has enough dentists to cover all the children that will be covered under the new law.

  • DENTAL PREMIUMS TO RISE Because of Obamacare, fees for all other family dental plans not covered by Medi-Cal or Healthy Families will be increasing by $7 to $15 per month, per child, according to The National Association of Dental Plans (NADP). An NADP spokesperson says the increases are due to new fees being charged to insurers and the cost of expanding benefits for more people currently uninsured.

  • UNINTENDED CONSEQUENCES The NADP estimates that as many as 11 million adults who currently have dental benefits won’t be able to afford coverage for themselves and their children so they will drop their own benefits, even with the subsidies built into the new program.  

The California Dental Association disagrees and believes oversight by the California Health Benefit Exchange will keep dental benefit costs manageable.

Sources: The California Report, Huffington Post, Newsmax

Copyright 2012, Bloom Insurance Agency, LLC

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