Affordable Care Act

Choosing Insurance Plans Within the Affordable Care Act

Child At Dentist

Beginning Jan. 1, 2014, the Affordable Care Act states that Americans currently without insurance and employers of fewer than 50 employees that choose to provide benefits must have plans with Essential Health Benefit Packages (EHBPs), unless their prior plans are grandfathered. They can start making their selections Oct. 1, 2013.


Review plan options

The following guidelines may be helpful in understanding plan options and the choices you need to make:

  • EHBPs will include pediatric dental and vision, typically for individuals up to age 19
  • Small employers are not required to purchase health coverage for employees and their dependents through a health insurance exchange, which means they may keep their current medical, dental and vision benefits with the same insurance carrier
  • Individuals are not required to purchase any health coverage through an insurance exchange
  • Insurance coverage may be purchased as stand-alone or in a private exchange through an employer or as individual coverage
  • Individuals may be assessed a financial penalty if they choose not to have essential coverage (unless they are specifically exempted)

Understand state exchange plans

  • Review plan designs carefully to understand coverage options
  • Plan choices will be limited
  • Employers will not be able to customize plans
  • Plans may not be cheaper than those offered by an insurance carrier in a private exchange market
  • Premiums may be based on limited criteria instead of utilization trends that are typically used from within an employer’s industry or claim experience
  • Premiums likely will include a fee that insurance carriers will be charged by state or federal administrators to participate in exchanges

Dental and vision insurance

  • Medical plans with dental or vision coverage in a public exchange likely will cover only children
  • Adults likely will need to purchase their own dental and vision plan
  • Adults and dependents with dental and vision through an exchange or EHBP could have different plans, networks and insurance carriers
  • The American Dental Association reports a national decline in adults visiting the dentist (from 41 percent in 2003 to 37 percent in 2010)
  • Visits to hospital emergency rooms for dental problems exceeded 2 million in 2010
  • Emergency treatment does not provide preventive care and early detection afforded by regular dental checkups

To learn more about dental and vision coverage options under the Affordable Care Act, review our Facts vs. Myths information and visit our Affordable Care Act section.