In the individual market, where you purchase your own insurance, many skip dental benefits.
Dental professionals hoped health reform’s insurance marketplace would improve coverage.
And it did. Sort of.
Dental Benefits Under Health Reform
Relieved dental benefits advocates applauded when health reform’s Affordable Care Act included dental care in its provisions.
Granted, it was coverage for pediatric dental service, but at least dental was included.
Small group and individual health plans in the insurance marketplace must include pediatric dental services as one of the ten essential health benefits.
Adult dental benefits are an option – not a requirement.
The biggest stumbling block is how the marketplaces offer dental benefits.
An American Dental Association (ADA) Health Policy Research Center research brief revealed the confusion surrounding dental benefits in the marketplace.
New legislation, like the Affordable Care Act, introduces various interpretations. One interpretation determined the following.
Health plans could exclude pediatric dental services IF stand-alone dental plans offered in the marketplace include those services.
Stand-alone dental plans are sold separately and offer dental benefits only.
That interpretation left the insurance marketplace with three options for pediatric dental benefits.
- Stand-alone dental plans
- Dental plans bundled with medical plans
- Medical plans that include those benefits
Open the door to variations.
Currently, there are NO bundled dental/medical plans. So that means consumers are down to two plan options – stand-alone dental plans and medical plans with pediatric dental coverage.
The following illustrates additional confusing issues.
Dental Benefits in the Insurance Marketplace
From my point of view, dental insurance remains broken; however, at least the marketplace did not totally abandon adult coverage.
Did you purchase dental benefits in the insurance marketplace? What did you find?
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Notice of Disclaimer –Cathy Miller is not an attorney or health care provider and cannot provide legal or health care advice. The information provided is for your general background only, and is not intended to constitute legal or health care advice as to your specific circumstances. We recommend you review legislation with legal counsel and visit your physician for health care issues.
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