Affordable Care Act

Will Health Care Reform Change Your Dental Benefits?

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Many Americans place high value on their dental benefits and are wondering if health care reform will impact their insurance coverage. While understanding medical coverage within health care reform can be challenging, there is nothing confusing about dental.

The best news is that you can keep your current dental plans.

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 benefits sold in stand-alone policies are not subject to most provisions.

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

However, children age 19 and under must have pediatric Essential Health Benefits (EHB), which include dental and vision coverage, unless their plans are grandfathered. Plans may be purchased as stand-alone or in a private exchange through an employer, individual coverage or public exchange options. The penalty for not purchasing this coverage is $47.50 annually per child.

Exchange plans with dental – for children only

It’s important to note that in a public exchange marketplace, medical plans with dental coverage likely will cover only children. This means that adults who purchase pediatric dental coverage for their kids will need to purchase their own dental plan separately. Adults and dependents with dental through an exchange or EHB plan could then have different benefit plans (and insurance carriers).

Employers and individuals exploring dental benefit options through a state exchange or private marketplace should review the plan design carefully to understand the coverage options.

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.

Learn more about insurance coverage in the ACA by reading these ameritasinsight blogs:

“How Will Health Care Reform Impact Adults?”

“What Are Pediatric Essential Health Benefits”