Posted September 8, 2014
Did you know that pediatric dental in a medical plan is not the same as pediatric dental in a stand-alone dental plan?
In March 2011, the American Dental Association determined that 10 million children ages 2 through 18 did not have dental coverage. Health professionals projected that parents and caregivers of many of these children would purchase plans with pediatric dental coverage through federal or state exchanges. But this choice may not provide the coverage children need, and parents expect.
Here are tips to help you understand the differences in coverage:
1. Dental within medical plans
When considering a medical plan with dental coverage embedded, know how the plan is designed, along with the carrier’s expertise with dental coverage and claims processing.
Design – The medical plan may cover preventive care for cleanings and checkups but feature a high deductible that must be met in full before medical or other dental services will be covered. This means that families with dental needs, such as fillings, crowns or root canals, may face large, unexpected bills. Experience indicates that families in this situation may decide to delay care, resorting to dental urgent care centers or hospital emergency departments if the pain becomes severe.
Orthodontia coverage – Dental coverage within a medical plan may cover only medically necessary orthodontia, such as cleft-palate conditions. This means children enrolled in an orthodontia plan to repair crooked teeth and bite problems no longer will have coverage.
Claims processing – People who have dental benefits tend to use them. Medical plans with dental coverage may struggle to process claims accurately and quickly, because their administrative systems are not set up to handle the unique requirements of dental claims.
2. Stand-alone dental
Stand-alone dental plans, which can be purchased separate from medical plans, offer comprehensive coverage for children and adults. Plans cover everything from preventive services to more complicated dental procedures. Currently, 98 percent of Americans with dental coverage have a dental policy separate from their medical policy.
Stand-alone dental plans typically are offered by carriers that are experts in dental, which means:
- Premium costs are accurate
- Benefits can be customized to meet employer and employee needs
- Customer service and claims processing systems are likely to be designed specifically for dental
- Some carriers also have a nationwide, credentialed provider network
3. Carrier expertise
Developing a pricing structure for dental coverage requires extensive experience to design the plan and set a predictable premium that employers and employees can rely on for budgeting. Some carriers offering dental don’t have the expertise to price coverage accurately. They may initially price plans low and then have to raise rates to cover unanticipated costs.
Adults need dental coverage
It’s important to focus on children’s oral health since baby teeth lay a foundation for dental and medical health throughout life. But adults also should realize the value of taking good care of their teeth and gums to avoid developing serious medical conditions. Adults purchasing a medical plan with pediatric dental coverage will need to purchase coverage separately for themselves and their dependents age 19 and older.
Want to learn more? Review this article about pediatric essential dental benefits.