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The Dental Insurance Landscape Post ACA

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Putting “politics aside,” Bruce Hentschel of Benefits Pro reports on The Post-Affordable Care Act (ACA) Dental Benefits “landscape”, especially as it relates to employers. In his analysis, Hentschel writes that confusion persists regarding the state of dental benefits on the ACA’s health insurance exchanges, and that even for something as straightforward as an Essential Health Benefit like pediatric dental coverage the options “are many.” The analysis then goes over several different situations and considers potential solutions. “The beauty of all this is that there are options available in the market for almost any situation,” he concludes.

As stated above, Essential Health Benefit like pediatric dental coverage is creating some confusion amongst Small Employers.

In the employer-directed article, “Demystifying the ACA’s Pediatric Dental Requirements for Small Employers”, the Insurance Broadcasting Institute reports on the Affordable Care Act’s pediatric dental benefit requirement. By adding the pediatric dental benefit requirement, it “has small employers facing a dilemma” as to whether they should “embed dental coverage within a medical plan or offer dental benefits as a stand-alone plan.” The article reported that the ACA recognizes “the tradition of standalone dental coverage” and “allows for health plans on the exchange to omit pediatric dental coverage so long as a standalone dental plan offering pediatric coverage is available for purchase on that exchange.” However, language of the final ACA rule has created confusion regarding off-exchange dental benefit plans, which is “where the majority of small groups continue to buy their plans,” according to Delta Dental vice president Christopher Pyle. Pyle went on to advise that small groups consult with a broker familiar with the specific rules in their state, as they may vary.

What happens if employers stop providing dental insurance coverage?

In the patient-directed article, “What To Do If Your Dental Insurance Gets Dumped,” by Health News Digest considers this scenario. Citing US National Institutes of Health Bioethics Department director Ezekiel J. Emanuel’s book “Reinventing American Healthcare,” Health News Digest reports that by 2025 “almost all major employers will not be funding health insurance plans and fewer than 20 percent of people working in the private sector will receive healthcare coverage through an employer,” meaning that the approximately 60 percent of people who currently receive dental benefits through work will have to find another way to obtain them. The article suggests that, in order to obtain a non-employer-provided dental plan, patients leave “no stone left uncovered,” shop around, visit dental schools for services at a reduced rate, and compare and contrast plans on the health exchanges.

More Resources:
Pediatric Dental Essential Health Benefit in Covered-California 2014
Covered California Changes 2015
Health Care and Insurance
Advocating for Dental Patient Rights and Insurance Benefits
How Will the ACA Affect My Child’s Dental Insurance?
The ACA and Orthodontics Update 2014
The ACA and Orthodontics
The ACA in 4 Minutes
The ACA and Children’s Dentistry in California
Finances and Insurance

–Dr. Jon and Team HappyHealthyTeeth


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