Affordable Care Act

Do You Know the Myths and Facts of the Affordable Care Act?

Affordable Care Act

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 the ACA will affect their benefits and budgets. And there are many Americans who are not aware that changes are coming.

A recent Kaiser Family Foundation poll discovered that 52 percent of respondents did not know the ACA was a law. Of this group, 12 percent thought Congress eliminated it, 7 percent believed the U.S. Supreme Court got rid of it, and 23 percent did not know whether or not the law existed. Even though the ACA is featured regularly in the news, nearly half of the people polled said they did not have enough information to know whether the law will impact their lives. Most were less concerned about how the ACA will affect people across the country and were more focused on the impact on their paycheck and budget.

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. Employers and insurance consultants can help employees understand the ACA’s effect on their dental and vision benefits.

Stand-Alone Dental and Vision Plans

According to the National Association of Dental Plans, about 98% 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.

Many Employers Can Keep Same Benefits

In the ACA, employers are not required to purchase any 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.

However, employers with 50 or more employees must offer Minimum Essential Coverage that is affordable and meaningful. But this does not include dental or vision.

As a note of caution, individual consumers choosing not to purchase health benefits may be assessed a small penalty, but it is not clear whether that extends to the purchase of pediatric dental or vision benefits in the small-group market.

Understanding Pediatric Essential Benefits

Under the ACA, there are 10 categories of Essential Health Benefits (EHBs) that must be offered to most individuals and small groups both inside and outside marketplace exchanges, unless the medical plan is grandfathered. One of these categories is pediatric dental and vision benefits, which will be offered within state insurance exchanges and to most small employers outside the exchanges.

Medical coverage offered within an exchange must include a pediatric vision and dental benefit. If the same exchange offers a stand-alone dental plan providing the required pediatric dental benefit, the medical plan has the option to exclude that benefit.

In an exchange marketplace, medical plans with dental or vision coverage likely will cover only members under the pediatric age (19 in most states). 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 purchasing dental or vision through an exchange or EHBP could then have different benefit plans than their children have.

Learn more about the impact of the ACA on insurance coverage by reading the Myth vs. Fact article developed by Ameritas group division.