Understanding How Health Care Reform Impacts Dental

children and health care reform

The Patient Protection and Affordable Care Act (PPACA) was signed into law by President Obama in March 2010. While some components of PPACA have been implemented, most provisions will commence in 2013 and 2014.

During 2012, we anticipate announcements concerning the dental insurance provision within health care reform. So let’s review the potential impact and consider steps that employers can take to prepare for anticipated changes:

  • Dental care for children – The dental focus of health care reform is to provide essential benefits for American children. Nearly six out of 10 kids in the United States have cavities, and about 25 percent have untreated decay in their permanent teeth, causing the U.S. Surgeon General to call kids’ tooth decay a silent epidemic. Dental experts have determined that the root system from baby teeth helps lay the foundation for permanent teeth. If kids have damage from cavities at a young age, they may experience a lifetime of tooth and gum problems. At this point, the age range, benefit options and plan design for essential dental benefits have not been determined. The National Association of Dental Plans (NADP) has created a helpful document that thoroughly reviews the issues and discussions on essential pediatric oral services.
  • Track dependents – While we await decisions on the essential dental benefits for kids, employers can develop a list of dependents receiving dental care through their parents’ plans, along with the birth date of each child covered. The government’s requirements may mean that some children will have a dental plan independent of their parents’ benefits. Developing this list is an excellent first step toward meeting compliance requirements once the age range for essential pediatric services is defined, and may result in less paperwork when administering dental benefit plans the following year.
  • Communicate the value of dental insurance – Research has shown that many employees enroll in dental plans to provide good oral care for their dependents. Since PPACA focuses on providing only pediatric dental care services, health professionals fear that some employees may decide to discontinue their dental benefits. If so, will they maintain preventive oral care with daily toothbrushing and flossing, and pay the out-of-pocket costs for regular cleanings and checkup appointments?

In February 2009, the NADP released the following statistics in its report, The Haves and Have nots: Consumers With and Without Dental Benefits:

  • Better oral health habits are reported by those with dental benefits – including brushing, flossing, visiting the dentist more frequently, and being less likely to have smoked
  • Among those without dental benefits, 44 percent cited lack of insurance as the reason for not visiting the dentist
  • People without dental benefits are less likely to have fillings, crowns and root canals, but are more likely to have extractions and dentures

In particular, employers should help younger employees understand the value of their dental benefits. Workers in this age group may not appreciate the full worth of their benefits. Many grew up enjoying good healthcare coverage through their parents’ plans and may not recognize the need for their own dental plan. They need to know how regular dental checkups and cleanings can help uncover the signs of more than 120 health problems and how maintaining good oral wellness can help them avoid unnecessary medical issues in the future.

To keep current with new information on health care reform, partner with a trusted insurance carrier and sales representative who can help you understand benefit changes and develop appropriate solutions.

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