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Does Obamacare require pediatric dental benefits?

Jan 14, 2013

Obamacare's implications for pediatric dental coverage
Photo Source: Ballantyne Pediatric Dentistry

Whether people are for the Affordable Care Act or against it, there is one thing everyone would agree on about the law that begins January 2014:  it’s confusing.

Health and Human Services (HHS) is still working out the rule making process about the law also known as Obamacare and lots of questions remain unanswered. Because of that lobbying groups are scrambling to obtain the best advantage for their clients, including lobbyists for the American Dental Association (ADA).

Below are four goals the ADA says it believes HHS should stress with state officials and the state insurance exchanges scheduled to open in October:

  • Stand-alone dental plans and medical plans with an embedded dental benefit must be able to compete on an equal footing inside the exchange to ensure consumers have a robust selection of dental products.

  • The pediatric dental essential health benefit must be a required purchase for all families with children who buy their coverage in the individual or small group market if the children do not already have coverage beginning January 1, 2014. (The small group market consists of individuals or small groups such as companies with 50 or fewer employees.)

  • Children up to age 21 should be covered by a dental benefit and there should be adult dental coverage for emergencies as part of state essential health benefit packages.

  • Periodic oral health services must be included in the package of essential health benefits offered through the exchanges.

The ADA estimates that up to three million children will gain dental coverage through the insurance exchanges by 2018, roughly a five percent increase over the current number of children with private benefits.

But they also caution that the expansion of children’s dental coverage in the exchange could be compromised if Obamacare determines the pediatric oral benefit offered is an essential health benefit but there is no assessed penalty for failing to purchase it.

There are many groups opposing different facets of Obamacare, including The National Association of Dental Plans (NADP). The NADP contends that premiums for family dental plans will rise $7 to $15 per month, per child beginning in 2013 due to new fees being charged to insurers and because of the cost of expanding benefits to those currently uninsured.

The NADP also estimates that the stand-alone dental plans currently available through employers are vulnerable to disruption because of Obamacare. The NADP website says that 43.7 million employees and their dependents will be affected by the new law and that 11 million adults currently with dental benefits won’t be able to afford coverage for themselves and their dependents.

HHS says many of the ambiguous issues described above will be clarified before the law goes into effect a year from now. So far only Washington and California have weighed in with plans for their respective states.

EDITOR’S NOTE:  Beginning January 1 Obamacare imposed a new tax of 2.3 percent on medical device manufacturers, including those making dental braces. It is all but certain the manufacturers will pass along the new cost to parents buying braces for their children. Depending upon the cost of the braces, the increase could be as high as $175.

Sources: Dentistry IQ, American Dental Association, National Association of Dental Plans, Americans for Tax Reform


Copyright 2013, Bloom Insurance Agency, LLC

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