Affordable Care Act

Dental and Vision Benefits Within the Affordable Care Act

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Will your dental and vision benefits be affected by the Affordable Care Act (ACA)?

On Oct. 1, 2013, Americans currently without insurance and employers of fewer than 50 employees that choose to provide benefits will have an opportunity to start reviewing insurance plan selections before the individual mandate goes into effect on Jan. 1, 2014. Before making decisions on medical insurance, it’s important to understand how dental and vision benefits fit within the ACA.

Under this mandate, individuals (with a few exceptions) who do not have Minimum Essential Coverage (MEC) through an employer, private or public exchange or public program must purchase benefits or pay a penalty. Employers of fewer than 50 employees do not have to offer medical or dental benefits, but those than choose to provide benefits must be offered the new Essential Health Benefit Packages (EHBP).

Understand Pediatric Essential Health Benefits
EHBPs will include pediatric dental and vision benefits for members under age 19. In public exchanges, operated by the federal government or individual states and the private market, pediatric vision will be embedded in medical packages. Pediatric dental may be embedded or offered separately. In most states employers and individuals purchasing through the exchange do not have to purchase pediatric dental.

Although dependents under age 19 must have pediatric Essential Health Benefits (EHBs), which include dental and vision coverage, these plans may be purchased as stand-alone or in a private exchange through an employer, individual coverage or public exchange options.

Keep Existing Dental and Vision Plans
Most Americans with dental or vision coverage have benefit policies separate from their medical policy. Under the ACA, dental benefits sold in stand-alone policies are not subject to most provisions.

Small employers are not required to purchase such 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 carriers.

Pediatric Essential Health Benefits with Ameritas
Recently, Ameritas introduced a pediatric dental option, called Better Benefit, which combines the best of traditional dental insurance and pediatric dental EHB. This plan features coverage for the whole family, including state-designated EHB coverage for members under the pediatric age. Members don’t need to risk giving up solid traditional dental plan elements to get the benefits of pediatric dental EHB. And to ensure members receive the best benefit for their premium dollar, Ameritas will compare each submitted pediatric dental claim and will pay the better coverage between the plans for members under the pediatric age.


To learn more information about dental and vision plans under the ACA, read these Ameritas Insight blog posts:

Will Health Care Reform Change Your Dental Benefits?

How Does Vision Insurance Fit Within the Affordable Care Act?

Understanding Private Exchanges for Insurance Benefits

Understanding Pediatric Essential Benefits