At the very basic level, the ACA defines pediatric dental as an essential health benefit along with items like emergency services and lab work. What that actually means for you all depends on how and where you are getting your health insurance going forward. Regardless of where you purchase health coverage next year, the adult members of your family have options when it comes to dental benefits. Companies like DentalPlans.com offer cost-effective programs that are available to everyone.
Q. I have heard that dental care is considered an Essential Health Benefit (EHB) under the ACA and all Health plans are required to provide me with dental insurance. Is this the case?
A. While the ACA does define dental services as an Essential Health Benefit forchildren; this does NOT mean dental will automatically be part of your familys insurance plan, or that you will be covered. Some plans include dental coverage, and there are also stand-alone dental plans for purchase in the ACA market, if you can’t find a health plan with children’s dental that fits your needs.
Q. Didnt the ACA define children as anyone 26 or younger?
A. The ACA requires health plans and issuers that offer dependent coverage to make the coverage available until the adult child reaches age 26. However, this guideline does not extend into the definition of pediatric under EHB. Pediatric is defined as under the age of 19 in most states, although states have the flexibility to extend such coverage beyond the age of 19.
Q. What plans are required to offer pediatric oral health services?
A.The ACA Marketplaces must offer plans that provide dental coverage for children. In the federal Marketplace and most state Marketplaces, you are not actually required to purchase dental insurance.
If you purchase a new policy outside of the ACA Marketplaces, your plan is required to cover childrens dental. If you have an exisiting plan, you may not need to add kids’ dental. Check with your provider to see if you plan qualifies to be “grandfathered.”
Only non-grandfathered individual and small group insurance plans are required to offer child dental on or after January 1, 2014.
Q. How do I know if my employer’s plan is a small group plan?
A. The best advice here is to ask whoever handles benefits at your office. The ACA defines small groups as 100 or smaller, but most states define small groups as under 50 employees. States are allowed to keep the definition of a small group at 50 until 2016.
However, this does not mean your employer must now offer you benefits. It only defines what they are required to offer if they do.
Q. If I purchase a medical plan on a state or federal ACA Marketplace, will it include dental coverage?
A. The short answer is maybe. ACA marketplaces are required to offer pediatric dental plans. They may be separate from the medical plan or they may offer medical plans that include dental.
Starting in 2014, the Affordable Care Act requires Americans to have health coverage or pay a fee. But this is not true for dental coverage. You do not need to have dental coverage to avoid the penalty. And for adults, dental coverage is not required to be included in any plans.
Q. I qualify for a subsidy and want to purchase a medical plan that includes dental on an ACA exchange. What do I need to consider?
A. Keep in mind; the plan offered through an ACA Marketplace may only cover your children. Make sure your childs dentist is in-network to limit your out-of-pocket costs. Medical plans covering dental may have a large combined deductible and non-preventive dental services may not be covered until the deductible is met. You will need to look at each plan closely. You will still get credit for your subsidy if you chose a health plan without dental. For more information on the ACA, visit www.healthcare.gov.
Oral health is an important part of overall health and wellness for every family member. Accessing affordable dental care through a dental savings plan is an affordable alternative to insurance. A dental savings plan is like a membership to a warehouse club- consumers pay an annual fee and get access to reduced rates for dental services, cosmetic dentistry and orthodontia, as well as vision services and pharmacy. DentalPlans.com has been a successful online marketplace for dental and vision savings plans, since 1999.
For more information on how our plans can help you and your family save on dental care and more, check us out at www.DentalPlans.com, or call us at 1-800-238-5163.