Kid At Dentist

How pediatric dental benefits will change under the ACA

Jan. 15, 2013
If you’re confused about how pediatric dental benefits will change in 2014, you’re not alone.

January 15, 2013

If you’re confused about how pediatric dental benefits will change in 2014, you’re not alone. Fortunately, Georgetown University Center for Children and Families has teamed up with Children’s Dental Health Project to tackle some key points of the new law. Director of Policy Meg Booth and Policy Analyst Colin Reusch from the Children’s Dental Health Project, along with Joe Touschner, senior health policy analyst from the Georgetown University Center for Children and Families, have compiled a list of issues for state advocates to consider before the law is fully implemented. Attached is the PDF, but here are some key points, as stated in the report:

  • Only 26% of small employers (1-49 workers) offer dental benefits.
  • Only about 1% of dental benefits are purchased on the individual market.
  • The average annual maximum benefit for employer-sponsored dental policies is about $1,500.
  • Children who receive dental benefits through plans sponsored by large employers as well as Medicaid and CHIP will keep the coverage they currently have as the ACA is implemented.
  • While medical plans have the option of providing a bundled benefit that includes pediatric dental coverage in exchanges, dental benefits may continue to be offered in a plan separate from other health care benefits. If a separate pediatric dental plan is offered in an exchange, individual and small group exchange plans do not have to offer pediatric dental benefits themselves. But if no separate pediatric dental plans are offered, then all exchange plans must offer these benefits to fulfill the EHB requirement.

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The report features a graph of how children will access dental benefits in 2014. It also addresses four distinct topics: how children receive dental coverage today, how the ACA will affect access to coverage for children, the choices states have, and recommendations for state advocates to consider when states choose their EHB (essential health benefits), which elaborate on these five suggestions:

  1. Carefully examine your state’s dental benefit benchmarks with particular attention to the CHIP dental benefit.
  2. Explore alliances with insurers who may offer coverage in the individual and small group markets.
  3. Emphasize the importance of network adequacy when it comes to choosing benefit plans.
  4. Carefully monitor implementation and share experiences with other states.
  5. Consider advocating for your state to adopt the CHIPA option to provide wrap-around dental benefits.

What do you think about these suggestions? Let us know in the comments below.

Lauren Burns is the editor of Proofs magazine and the email newsletters RDH Graduate and Proofs. She is currently based out of New York City. Follow her on Twitter: @ellekeid.