14:35 PM

What is the Role of Dental Benefits in Healthcare Reform?

By Steve Pollock, DentaQuest Chief Operating Officer

Starting on January 1, 2014, public healthcare exchanges will be required to offer pediatric dental benefits to individuals and small groups, meaning as many as 20 million children will have new benefit plans and, consequently, better access to important dental care—many for the first time in their lives.

At DentaQuest, we think this is great. The oral health of our children is an important, far-reaching issue, and one that hasn’t always gotten the attention it should. Consider this: dental disease is the most common chronic disease among children – five times more common than asthma. Children lose 52 million school hours each year because of dental disease. Poor oral health can affect nutrition, speech development, and learning during critical developmental years, putting many children at a serious disadvantage for life. None of this should be the case, because dental disease is almost 100% preventable.

The details of the Affordable Care Act (ACA) can be confusing, to say the least, and many aspects of the new law are still being defined. DentaQuest has been monitoring healthcare reform closely, and developed these questions and answers to help keep you informed of how the law impacts dental coverage. Here are some basics that you should know.

Q: Is dental coverage an essential benefit?
A: There are ten essential benefits. Pediatric dental and vision coverage is one of the ten.

Q: How is pediatric defined?
A: The ACA defines “pediatric” as up to 19 years of age. At DentaQuest, we cannot stress enough the importance of including child-specific services in the essential health benefits package. This is a crucial step toward improving lifelong oral health.

Q: What is covered by the pediatric dental benefit?
A: The U.S. Department of Health and Human Services (HHS) gives states two options for defining the pediatric component of the essential health benefit. Pediatric dental benefits can mirror (a) those offered through the state Children’s Health Insurance Program (CHIP) or (b) those offered through the largest Federal Employees Dental and Vision Insurance Program (FEDVIP). Today, both of these programs cover dental visits for children including preventive services such as routine dental exams, x-rays, sealants, fluoride varnish treatments, restorative services such as fillings, and other necessary dental services.

Q: What about adults?
A: Adult dental coverage is not one of the ten essential health benefits mandated in ACA. If your current health plan doesn’t offer dental benefits, you have the option of buying a dental plan separately.

Q: What is “the exchange”?
A: Healthcare exchanges are new virtual marketplaces where consumers can go to shop for and compare qualified health plans and qualified dental plans. All plans offered on a public exchange must offer the essential health benefits outlined by the ACA. Exchanges ensure that pediatric dental and vision care are offered to anyone purchasing benefits, thereby expanding access to dental care for all eligible children.

Q: When will people sign up for benefits through exchanges?
A: Open enrollment is scheduled to begin in October 2013, with new members coming on board on January 1, 2014.

DentaQuest’s in-house healthcare reform and government relations staff members are closely monitoring developments related to the ACA. Watch this blog for updates on new details as we learn them.