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How Obamacare Will Impact Kids' Dental Access

Obamacare seems to have little significance on oral health care; however, the new law does heavily target one population: children.

The American Dental Association estimates that through health insurance exchanges alone, an estimated 3 million children will gain dental benefits by 2018. In a report addressing the ACA’s potential effects on dentistry, the ADA called this a roughly 5 percent increase over current numbers. The report also noted that a significant number of children will gain dental benefits through plans sold outside the exchanges including employer-sponsored plans.

When the Affordable Care Act’s health insurance mandate goes into effect on January 1, 2014, individual and small group health insurance plans—those sold in the private market as well as federal and state health insurance exchanges—must cover essential health benefits. EHBs include items and services in 10 major categories. Pediatric services, including oral and vision care, is among them.

What services will be included?

Benefits may vary from state to state. Under the new law, each state has been required to select a benchmark plan. All health insurance plans sold within the state must follow that standard when it comes to items and services covered.

In circumstances where the benchmark plan does not have embedded dental coverage, the Federal Employees Dental and Vision Insurance Program or the state’s CHIP program will serve as the benchmark for this category.¹

Plans with embedded dental may include common, relatively low-cost preventive, diagnostic and emergency procedures, while a CHIP program may have more robust benefits including medically necessary orthodontia.²

What is the age cut off?

According to the Department of Health and Human Services final rule on EHB, pediatric refers to individuals under age 19. However, states are allowed to “extend pediatric dental coverage beyond the 19-year age baseline.”

Will a separated dental plan need to be purchased?

It depends. If you are covered through an employer, then yes.³ If you purchase a major medical plan with embedded dental coverage, then it is up to you whether you want a separate dedicated dental plan with additional benefits and services.

An analysis by the Georgetown University’s Children’s Health Policy Blog states that EHB covered plans sold within the exchanges may omit pediatric dental benefits if those benefits are offered by a stand-alone plan.

What about grandfathered plans?

Plans continuously in effect as of or prior to March 23, 2010, are considered grandfathered and exempt from Obamacare’s provisions. If you and your family are still covered under such a plan, then the pediatric services requirement will not apply and you must purchase a separate dental plan for your children.

Kaiser Health News examines Obamacare and children’s dental coverage in “Health Law Offers Dental Coverage Guarantee for Some Children”


1 "Essential Health Benefits: Basic Facts & Frequently Asked Questions ." MN.gov. Minnesota, 5 10 2012. Web. 26 Feb 2013. http://mn.gov/health-reform/images/WG-Access-EHB%20Fact%20Sheet%20and%20FAQs%2010-05-12.pdf.

2 Fontana, Joanne. "Healthcare reform: What about dental." Milliman. Milliman, n.d. Web. 26 Feb 2013. http://publications.milliman.com/publications/healthreform/pdfs/healthcare-reform-dental.pdf.

3 Rogers, Kate. "The Struggle to Get Low-Income Kids Dental Care Under PPACA." Fox Business. 23 02 2013: n. page. Web. 26 Feb. 2013. http://www.foxbusiness.com/personal-finance/2013/02/20/struggle-to-get-low-income-kids-dental-care-under-ppaca/



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