Dental Insurance Plans and The Affordable Care Act

Dental Insurance Plans and The Affordable Care ActAccording to the Pew Center report, approximately 5.3 million children are expected to gain dental coverage after 2014 as part of the Affordable Care Act.

The Act includes a plan for pediatric dental insurance plans that will be sold in insurance exchanges, both packaged with adult plans and as stand alone plans, as reported by Healthcare Finance News.

Joanne Fontana, an actuary who tracks healthcare and health insurance for the actuarial and consulting firm Milliman, told Healthcare Finance News, “It’s a very, very big shift from the way dental insurance is currently sold. For the first time, there’s a need for pediatric-only plans. State and federal governments still need to decide benefit levels and cost structures for stand-alone dental plans and medical-dental packages, in and outside of the exchanges.”

Many states have yet to figure out whether or not they will offer exchanges and the details of changes to insurance plan offerings.

There is still a lot of confusion about how the Affordable Care Act will be implemented.

Part of the confusion stems around whether or not health insurers will be able to offer medical plans without pediatric dental plans for individuals and small groups, and through the exchanges.

There is also concern that children will have duplicate dental insurance coverage, or families who have separate dental plans will be forced to have their pediatric dental plan changed to fall under their health insurance plan.

This could mean being forced to change dentists, which is something many parents and dentists alike will not be happy about.

“Another uncertainty comes from ACA rules on cost sharing limits for essential health benefits. Hypothetically, if someone has a medical plan for themselves and his or her child, and has a separate dental plan for the child, somehow the two insurance companies have to co-administer cost sharing limits–a problem without easy solutions.” Fontana advised Healthcare Finance News. “If you’re going to administer that, you would have to have claims accumulators going on the medical side and claims accumulators on the dental side that would have to talk to each other. For that to happen in reality, it’s just not a pragmatic solution.”

ADA members are increasingly concerned about the effects the ACA will have on their dental practices in 2014.

What are your thoughts about dental coverage in the Affordable Care Act? How do you think it will affect your dental practice? Let us know in the comments!

For more on this story see: Dental Insurers Eye 2014, Await Regulatory Guidance


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