PLANTATION, FL (Feb. 10, 2014)—As the Affordable Care Act (ACA) discussion switches from accessing the federal and state health exchange web sites, to what care is provided, millions of Americans are finding out that dental care for adults and seniors, and even children in some cases, remains uncovered. According to the National Association of Dental Plans, 126.7 million Americans lack dental coverage nationwide—nearly three times the number of medically uninsured.
Here is a look at how the ACA may affect your family’s access to dental care.
While the ACA defines dental services as an Essential Health Benefit (EHB) for children (up to 19 years), this does not mean that dental care will automatically be a part of a family’s insurance plan or that they will be covered. The ACA marketplaces are required to offer pediatric dental plans, but they may be separate from the medical plan and sold as stand-alone policies. It is these stand-alone policies that worry experts and deter consumers from the exchanges. Families who opt not to buy stand-alone dental coverage for their children won’t be penalized. And if they do purchase a stand-alone dental plan, it won’t be eligible for a federal subsidy, even if they are eligible for help in buying their overall health plan.
Connecticut is one of the few states that offers pediatric dental in all of its health plans. Some states require parents to purchase stand-alone dental plans, like Washington and Nevada. State exchanges in New York and Massachusetts, and most of those run by the federal government, offer a choice of health plans with or without embedded pediatric dental benefits and stand-alone plans. Each state has a lot of leeway in determining what dental services are offered, especially when it comes to setting deductibles, co-payments and co-insurance. That leaves families vulnerable to the possibility of paying thousands of dollars for dental care even though they have insurance. Families should consider their children’s potential dental needs and how the costs are applied when evaluating plans in their state.
Overall, dental coverage for adults is decreasing due to the elimination of adult dental Medicaid benefits in many states. In 2010, 22 states provided no adult Medicaid dental benefits, and since that time additional states have severely curtailed their dental benefits. And as a result of the ACA, the National Association of Dental Plans has estimated that up to 11 million Americans may drop dental coverage when their children are removed from their dental policies.
The ACA does not require adults to be covered for dental services in medical plans. Therefore, adult dental benefits have to be purchased separately, because they are optional under the law. Stand-alone dental plans may be available through the federal health exchange, healthcare.gov, but only with the purchase of medical insurance plans. For example, if you have health insurance through your employer, but not dental insurance, you won’t be able to buy just dental coverage on healthcare.gov.
As the Baby Boomers retire they will lose employer sponsored insurance and need to pay out-of-pocket for dental care or obtain alternative coverage such as through a Medicare Advantage plan. According to a recent study prepared for the American Dental Association, two-thirds (66 percent) of adults 65 and over have no dental coverage. For the most part,Medicare has never covered comprehensive dental benefits for seniors; the program pays only in certain cases where dental and medical needs intersect. And only two percent of retirees have dental coverage through a prior employer, according to Oral Health America.
When evaluating marketplace plan options, individuals and families should consider the following factors:
- Identify covered dental or vision services, co-payments and reimbursement percentage levels.
- Know the deductible that must be met before non-preventive services are covered.
- Review the network to see whether changes in providers may be needed.
- Understand whether there is a waiting period that must be met before using the benefits.
- Know whether there are exclusions or conditions for coverage.
- Know whether the out-of-pocket maximum applies separately to dental or if the medical out-of-pocket applies.
The goal of health care reform is to extend affordable benefits to Americans who may not have had the opportunity to purchase them in the past. This mainly includes individuals who are self-employed or work for small employers with fewer than 50 employees. This however, does not include most dental and vision benefits sold in stand-alone policies, which account for 98 percent of dental and vision benefits for adults. The ACA really falls short in covering this gap for most Americans when it comes to their dental care.
“We think quality dental care should be accessible and affordable to everyone,” says Jennifer Stoll, president of DentalPlans.com. “That’s the basic premise of DentalPlans.com, to provide access to quality services in a format that provides information that is easy to understand. Oral and vision care is an essential part of a person’s overall health and well-being and lack of coverage can really impact your quality of life. We in fact are already a private exchange for dental savings plans, and have been operating as a marketplace since 1999.”
Sweeping changes in dental coverage are driving growth in the discount dental plan market, according to the National Association of Dental Plans (NADP). As the ACA is instituted, approximately 30 to 40 million people will enter the dental benefits market and another 10 to 20 million people will either lose or change their current benefit plans. As a result, more dental patients will pay for their services in cash, making dental savings plans, like those offered by DentalPlans.com, a more popular choice for Americans.
Dental savings plans provide programs that help individuals, families, and groups save on their dental care and other health-related services, with one low annual fee. Similar to a warehouse club, consumers pay an annual fee and get access to significantly reduced rates on dental services, cosmetic dentistry and orthodontia, as well as vision and prescriptions, depending on the plan they choose. Services may include annual cleanings, x-rays, crowns, root canals, and even cosmetic and orthodontic procedures, not typically covered by insurance.
The benefits of a dental savings plan include savings of 10 to 60 percent off what you would pay without a savings plan or insurance, no waiting to use your plan, no claims to file, no limit on how often you can use your plan, and offer an open-enrollment. Even if you already have dental insurance, the dental savings plans may be used along with your dental insurance for even more savings on your dental care once your annual maximums have been met. The savings can be substantial. For example:
Plan:Careington Care 500 Series
Scenario: Two Adults and Two Dependent Children
Annual Family Membership Fee: $189.95
Using the Careington Care 500 Series plan, which costs a low annual fee of $189.95, a family of four could save $626 just on their annual ADA recommended treatments alone. That’s $436 in savings, when including the cost of the plan. And the savings can really add up when considering additional dental care that may be needed for you and your family, like sealants for children’s teeth, crowns, braces, and more.