Affordable Care Act

How Will Health Care Reform Impact Adults?


Across the country, people have been anticipating changes that will occur with insurance and health care under the Affordable Care Act (ACA). Many are looking forward to having access to health care insurance, while others are concerned about how health care reform will affect their benefits and budgets.

Impact on adults

As of January 1, 2014, all Americans (with a few exceptions) will need to have health insurance, or pay a penalty. The one-time penalty for individuals without insurance in 2014 will be $95/adult, or 1 percent of their income, whichever is greater. For every uninsured child, the penalty is $47.50.  To learn more about health care options under the ACA, read this article by The Washington Post.

Dental and vision insurance

There are many misconceptions about the ACA, especially how it relates to dental and vision coverage. While medical coverage impacts are confusing, dental and vision are easier to understand.

According to the National Association of Dental Plans, 98 percent of Americans with dental coverage have a dental benefit policy separate from their medical policy. Under the ACA, dental and vision benefits sold in stand-alone policies are not subject to most provisions. Only pediatric dental and vision benefits are part of Essential Health Benefit Packages (EHBPs), which are required to be offered to most individuals and small employers, unless their medical plans are grandfathered.

With ACA, individuals are not required to purchase any health coverage through a health insurance exchange. If their employer continues to offer medical, dental and vision benefits, they can keep their plans with the same insurance carrier.

Exchange plans with dental or vision – for children only

In an exchange marketplace, medical plans with dental or vision coverage likely will cover only children. This means that adults who purchase pediatric dental and vision coverage for dependents will need to purchase these benefits separately to maintain their own health. Adults and dependents with dental or vision through an exchange or EHBP could then have different benefit plans (and insurance carriers).

Employers and individuals exploring dental or vision benefit options through a state exchange or private marketplace should review the plan designs carefully to understand the coverage they will receive.

Plans offered in an exchange may not be cheaper than those offered by an insurance carrier in a private market. Premiums probably will be based on limited criteria instead of utilization trends that are typically used from within an employer’s industry or claim experience. Since insurance carriers will be charged by state and federal governments to participate in exchanges, these fees likely will be included in the premium costs.

For information about how the ACA will impact children, read these ameritasinsight blogs:

What are Pediatric Essential Health Benefits?

Understanding Pediatric Essential Benefits