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obamacare-dental-tips

 

Let’s just admit it: The Affordable Healthcare Act is confusing.

Take dental coverage, Dental care for kids is one of the ten Essential Health Benefits under the ACA. For the record, those ten Essential Health Benefits are:

  1. Outpatient care: treatment and care you receive outside a hospital
  2. Emergency room treatment
  3. Inpatient care in the hospital
  4. Maternity care, before and after your baby is born
  5. Mental health and substance use disorder services, including behavioral health treatment, counseling, and psychotherapy
  6. Prescription drugs
  7. Services and medical devices to help you recover if you are injured, or have a disability or chronic condition. This includes physical and occupational therapy, speech-language pathology, psychiatric rehabilitation, and more.
  8. Lab tests
  9. Preventive services including counseling, screenings, and vaccines to keep you healthy and care for managing a chronic disease.
  10. Pediatric services, including dental care and vision care for kids

Number 10 would logically lead you to think that dental coverage for kids must be included in any healthcare plan that meets ACA requirements. But you’d be wrong.

The ACA and Dental Coverage

Somehow, “essential,” as defined by the ACA – and only when it comes to dental insurance – means “available for you to purchase.” Essential doesn’t mean (at least regarding dental insurance) that coverage must be included with a plan, or that you have to get it for your kids.

It’s odd, but since health insurance typically did not include dental coverage, those who drafted the ACA didn’t want to mandate its inclusion in the new ACA healthcare plans. That said, a few states do mandate that pediatric dental coverage be included in all plans. And plans sold on the private insurance market must include dental coverage for kids.

So here’s what you need to know:

  • If you buy a plan on the federally-run Marketplace, you are not legally required to purchase dental insurance for your children.
  • If you if you live in California, Connecticut or Washington State and buy a plan from the state-run Marketplace, your plan must include pediatric dental coverage.
  • If you purchase a plan on the private market, you may need to either purchase dental insurance (whether you have children or not) or provide reasonable assurance that you have purchased it or intend to do so.

Purchasing ACA Dental Insurance

You can’t purchase just dental insurance on the ACA marketplaces – you have to also purchase a health plan. Your health plan may include dental, if not you can purchase a standalone plan. But if you buy a standalone dental plan, it will not be eligible for a federal subsidy to reduce the plan’s cost.

A healthcare/dental bundle does qualify for federal subsidies, but healthcare plans covering dental may have a large deductible that applies to dental as well as medical care. So you’ll be paying out of pocket for dental care until you meet your deductible – the average deductible is $5,731 for individuals and $11,601 for families. Try to find a dental insurance plan that offers a separate, lower deductible for dental care.

Do check which services are covered under your plan – don’t assume you can easily cover the deductible just because your kid needs expensive braces. Orthodontic care, and other services like dentures and implants, may not be covered by every plan.

Officially, preventative dental care is covered at 100% - that means for free- on Obamacare pediatric dental plans. But this coverage does not necessarily reflect what many parents – and dentists - consider to be minimum preventive care. Oral health risk assessments – a basic review of how likely your child is to have dental issues at some point in their lives - is covered. Cleanings, x-rays and other basics are not required to be covered if dental coverage is embedded in your health plan.

Dental savings plans offer an affordable alternative to dental insurance. With a dental savings plan, you gain access to a network of dentists who have agreed to offer reduced rates to plan members – typically 10%-60% of the cost of virtually all dental care and treatments.

There are no exclusions for preexisting conditions, no annual spending limit, no deductible to meet, and no claims to file. You simply pay the discounted rate directly to your dentist.

Find out more about family dental savings plans at dentalplans.com.
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