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Is Pediatric Dental Coverage Required Under Obamacare?

Is Pediatric Dental Coverage Required Under Obamacare?

 

Consumers have had a lot to learn under the Affordable Care Act—especially since 2014, when the individual shared responsibility provision took effect and required most Americans to obtain health insurance.

Following the third Obamacare open enrollment period, we all seem to understand the law a little more and what it does and does not require. However, our education is ongoing, and there are still some uncertainties.

One common question: Does Obamacare mandate that kids have dental insurance?

Not exactly, but the law does require coverage be made available to kids. These are the basics when it comes to the Affordable Care Act and children’s dental coverage[1]:

  1. Pediatric services, including oral and vision care are among the ACA’s 10 essential health benefits— also known as EHBs, these are a set of healthcare services categories that must be included in all major medical health insurance plans sold through the state-based and federally facilitated exchanges as well as in the private market.
  2. Because it is an essential health benefit, dental coverage must be available to children 18 and younger as part of a health insurance plan or as a standalone plan.
  3. Parents are not required to buy dental insurance for their kids—it is optional for everyone and there is no penalty for going without it; however, as mentioned above, it may be part of a health insurance plan.

What are the Obamacare pediatric dental benefits?

Pediatric dental benefits will look a bit different from state to state. Each state selects an EHB benchmark plan, which sets the standard for all health insurance plans sold within that state—all other plans must be substantially equal to the benchmark.[2]

If the state’s benchmark plan doesn’t include pediatric dental benefits, the Federal Employees Dental and Vision Insurance Program with the largest national enrollment or the state’s CHIP program will serve as the benchmark for this category.[3]

Check with your plan or the plan you are considering for detailed information about its pediatric dental benefits.

What do you do if your child’s Obamacare plan doesn’t include pediatric dental benefits?

If you are not certain, then contact the health insurance company and verify that this is, indeed, the case. You will then want to purchase a standalone dental plan for your child—and, possibly, your entire family.

Can I buy dental insurance outside open enrollment?

Yes. Dental plans are available year-round, which means you can buy one anytime, not just during open enrollment. You can buy individual and family dental plans from:

  • Health insurance producers, including the certified advisors available by calling the number at the top of your screen
  • Websites such as www.healthedeals.com and www.dentalinsurance.org
  • Your state-based or federally facilitated exchange
  • Insurance companies that sell dental plans in the private market

There are many dental plan designs on the market, and they can often be customized to meet your household and dental care needs.

Why would my child need dental insurance?

Tooth decay is the most common chronic disease among U.S. children, and the CDC reports that more than 40 percent of kids have it by the time they reach kindergarten.[4] Preventive dental exams and cleanings are an important part of maintaining healthy teeth and gums at all stages of life.[5],[6] Research shows that people with dental insurance are more likely to visit the dentist for these services and other dental care.[7]

Dental plans can help lower what you pay out of pocket for your child’s dental care—as well as your own, if you also have dental coverage. While benefits vary by plan, dental plans typically include coverage for the following types of care[8]:

  • Preventive – e.g., routine exams, professional cleanings, X-rays, sealants for certain age groups
  • Basic – e.g., fillings, extractions, root canals, treatment for gum disease
  • Major – e.g., crowns, bridges, inlays, dentures

Plus, some dental plans offer an optional orthodontic discount program.

If you have questions about dental benefits for your family or need assistance in selecting a plan, please call the number at the top of your screen to speak with a certified advisor.

 

Find Family Dental Benefits

 


 

[1] HealthCare.gov. “Dental Coverage in the Marketplace.” https://www.healthcare.gov/coverage/dental-coverage/

[2] Centers for Medicare & Medicaid Services. “Information on Essential Health Benefits (EHB) Benchmark Plans.” CMS.gov. https://www.cms.gov/cciio/resources/data-resources/ehb.html

[3] Ibid.

[4] Children’s Dental Health Project. “FAQ: Pediatric Oral Health Services in the Affordable Care Act (ACA).” https://www.cdhp.org/resources/165-faq-pediatric-oral-health-services-in-the-affordable-care-act

[5] American Dental Association. “Decay.” http://www.mouthhealthy.org/en/az-topics/d/decay

[6] American Dental Association. “Gum Disease.” http://www.mouthhealthy.org/en/az-topics/g/gum-disease

[7] Bloom, Barbara, et al. “Dental Insurance for Persons Under Age 65 Years with Private Health Insurance: United States, 2008.” NCHS Data Brief. No. 40. June 2010. http://www.cdc.gov/nchs/data/databriefs/db40.pdf

[8] National Association of Dental Plans. “What Do Dental Plans Normally Cover?” NADP.org. http://www.nadp.org/Dental_Benefits_Basics/Dental_BB_3.aspx

DENTAL
THIS PLAN DOES NOT MEET MINIMAL ESSENTIAL COVERAGE REQUIREMENTS FOR PEDIATRIC DENTAL SERVICES AS PART OF THE ESSENTIAL HEALTH BENEFITS IN ACCORDANCE WITH THE AFFORDABLE CARE ACT (ACA) PROVISIONS.

About The IHC Group
The IHC Group is an organization of insurance carriers and marketing and administrative affiliates that has been providing life, health, disability, medical stop-loss and specialty insurance solutions to groups and individuals for over30 years. Members of The IHC Group include Independence Holding Company (NYSE:IHC), American IndependenceCorp. (NASDAQ: AMIC), Standard Security Life Insurance Company of New York, Madison National Life Insurance Company, Inc. and Independence American Insurance Company. Each insurance carrier in The IHC Group has a financial strength rating of A- (Excellent) from A.M. Best Company, Inc., a widely recognized rating agency that rates insurance companies on their relative financial strength and ability to meet policyholder obligations. (An A++ rating from A.M. Best is its highest rating.) Collectively, the companies in The IHC Group provide insurance coverage to more than one million individuals and groups. For more information about The IHC Group, visit www.ihcgroup.com.

About IHC Specialty Benefits, Inc.
IHC Specialty Benefits, doing business as Health eDeals Insurance Solutions is a full-service marketing and distribution company that focuses on small employer, individual and consumer products. Health eDeals markets products through general agents online, telebrokerage, advisor centers, private label and directly to consumers. For more information about Health eDeals visit www.HealtheDeals.com.