How Affordable Care Act Will Affect Your Child’s Dental Care
Pediatric dental and vision services are among the Affordable Care Act’s 10 categories
of essential health benefits
(EHB). Health insurance plans must include certain items and services in these categories
at no additional cost to consumers starting January 1, 2014.
Many consumers view this inclusion as positive yet confusing. Dave Keller, Chief
Sales and Marketing Officer for IHC Health Solutions, spoke with DentalInsurance.org
to help us understand child dental and vision services.
Dentalinsurance.org: Does no additional cost to consumers mean that pediatric dental
and vision coverage is now free for kids?
Keller: There is no additional cost sharing, but that does not necessarily mean
no cost. If you have preventive services or examination then there is no cost sharing,
but there is still a cost. You just won’t have to pay out of pocket for certain
To me this is the most confusing aspect of the health care reform law. Maternity
is maternity; mental health is mental health, but pediatric dental and vision coverage
is not as clear-cut.
What services will be covered?
One of the different things for parents is there will not be uniform benefits. State
and federal benchmark plans
will determine what items and services are covered.
For instance, it cannot be assumed that children will have access to unlimited coverage
for orthodontia. In most instances orthodontia will be limited to medically necessary
treatment, not cosmetic and there will be some cost sharing most likely. Parents
are really going to have to understand what the benefits are in their state and
purchase additional coverage based on their family’s needs. Checkups and preventive
(X-rays, etc.) will certainly be uniform among states; beyond that it will be really
tough to guess what they might be.
How can consumers obtain pediatric dental insurance and vision coverage for their
There are two ways you can get this benefit: It can either be embedded in a health
plan or purchased standalone.
When consumers go to purchase a health plan, if the plan provider has reasonable
expectations that you have access to pediatric dental and vision—for instance, a
standalone dental plan on an exchange—then they don’t have to embed it. By the same
token, if your state’s exchange doesn’t have a separate pediatric dental insurance
and vision plan, the health plan must build it in.
What is the age cap on this benefit?
One of thing different about this benefit is that it is covered through age 19,
which really isn’t an age that is used elsewhere in the Affordable Care Act or the
industry. If you ask the American Dental Association what pediatric dental includes,
they would say it ends at age 12. With the Affordable Care Act, health insurance
coverage on a parent’s plan goes until age 26. The state health plans such as Medicaid
and CHIP go until age 21 in most states.
Stopping at age 19 for pediatric dental insurance and vision services stems from
early in the Affordable Care Act when insurance companies couldn’t deny coverage
to children 19 and under with preexisting conditions.
Will pediatric dental and vision services really impact children’s access to dental
and vision care?
I do think this is one of the things that is going to help a lot. If you look at
the people that have dental insurance and vision, it includes about 7 of 10 groups
with 500 or more employees; that’s based on a Georgetown University Dental Survey . Only about a quarter
of those under 50 provide it, so this will be a big expansion of children having
There is a lot of proof that ties good dental health to good overall health. There
are lots of studies that say vision problems that go uncorrected hold children back
in school. This provision provides low-cost method of securing a very important
benefit to children a lot of whom do not have coverage right now.
Also, once parents see the value, they will likely start rethinking their own coverage,
‘My kid has dental and vision coverage; shouldn’t I have it, too?”
There will be a lot of options off the exchange for dental and people will really
need to dig in and decide if they want an insured dental plan, discount coverage
or no coverage at all. If they think a dental plan is right for the entire family,
then they will need to research what kind and talk to a broker. In general, rates
vary widely, but it is reasonable to expect to spend around $40 to $50 a month on
a family dental plan.