The government shutdown has ended and it’s time for all of us to look ahead toward the changes coming our way in 2014 concerning, most significantly, Obamacare—officially called the Affordable Care Act (ACA). Open enrollment for the ACA began October 1, 2013, but with so many modifications to our health care, many people still have questions about how the new health care law will affect their dental coverage. We hope to address some of the common concerns about dental care under the ACA and a solution that is both helpful and affordable for everyone.
Is Dental Care Covered?
Pediatric Oral Care
Pediatric oral care is included as part of the minimum Essential Health Benefits (EHB) package for small groups and individuals both inside and outside of exchanges. This means it must be made available to children under 18 years of age, but they are not required to have dental coverage under the federal exchange. (There are a few states, however, that do require pediatric oral care under their state-run exchange. You can find out which states have a state-run exchange on The Commonwealth Fund map). The EHB package may be included either as part of the medical policy purchased or as a stand-alone plan within the exchange. Each individual state will determine what this package will cover and what age limit to apply. The expectation is that in most exchanges it will cover the majority of services offered by the Children’s Health Insurance Program (CHIP)—such as exams, cleanings and fillings—for children 18 and under.
Some early supporters of the ACA, such as lawmakers and children’s health advocates, are concerned that families who don’t qualify for Medicaid or the Children’s Health Insurance Program may not be able to afford this.
If a stand-alone, pediatric dental policy is purchased from a federally run exchange, annual out-of-pocket expenses for families could be as high as $700 per child or $1,400 per family, according to Colin Reusch, a senior policy analyst with the Children’s Dental Health Project. Reusch also notes that the cost of stand-alone coverage will not count toward the medical out-of-pocket limit built into the health care insurance policy. Additionally, there will be no tax credits available to help pay for stand-alone pediatric dental plans like there are for medical premiums.
Adult Oral Care
Dental care for adults is not considered an Essential Health Benefit. Neither the Affordable Care Act nor most Medicare includes adult dental coverage. However, many exchanges (state or federal) will allow for non-pediatric dependents to be added onto the pediatric dental plan purchased. The benefits of the plan will likely not be as good for adults as they are for children.
An estimated 17.7 million adults could gain some type of dental coverage through the ACA, but overall the ACA will only reduce the number of adults who don’t have dental insurance by approximately five percent, according to the American Dentist Association. And those who will benefit from the ACA will still need some assistance considering there will not be any subsidies offered in conjunction with the new healthcare law.
What Will Happen to My Current Dental Coverage?
If you already have dental coverage, your plan shouldn’t change. Some companies may be cutting back on their dental coverage because of the increase in healthcare, but they should notify you of any changes before they are implemented.
[Update 11/20/2013: Since the writing of this article, your plan not changing is now up for debate. You should still be notified before any changes are implemented, but be aware that there are millions of people whose plans are changing as a result of the Affordable Care Act]
The UC Berkeley Labor Center predicts the Affordable Care Act will result in changes for some of the 150 million Americans who are covered through an employer-sponsored plan. Employers are not required to provide this coverage for their employees, but large employers with at least one full-time employee will be required to participate in the exchange or they will be subject to a penalty beginning in 2014.
If you find yourself in this situation or any other situation where you need to compromise your dental coverage, consider applying for a discount dental plan, which can be both cost-effective and readily available to you.
How Discount Dental Plans Can Help
With the many changes coming beginning January 1, 2014, and the millions estimated to either drop their dental coverage or lose it, discount dental plans can be a great help.
Discount dental plans will not be affected by the Affordable Care Act so current discount plan members will continue to receive discounts once the Act goes into effect, and new members will be able to receive the same rates offered to current members.
Anyone can be a part of a discount plan. The plans have low annual fees and huge discounts on dental work so they are affordable even with the increased costs of healthcare. These plans start immediately so there are no waiting periods and some discount plans even come with a free vision plan, which is another segment that is not covered for adults under the Affordable Care Act.