How the Affordable Care Act will Most Impact Dental Coverage

By Jenifer Dorsey

Many Americans still want to know how the Affordable Care Act will affect dental coverage. In short, the health care reform legislation does not have much impact on oral health benefits. Dental insurance will not be required when the individual mandate takes effect January 1, 2014, and most ACA provisions do not apply to dental plans.

Mostly, when it comes to dental, ACA helps the kids.

For the most part, the law does not expand access to dental care for the majority of Americans. Pediatric dental and vision benefits, however, are listed among the Affordable Care Act’s 10 essential health benefits categories, which are commonly called EHBs. That means pediatric dental benefits must be offered through health insurance exchanges; the benefits may be embedded into participating individual health insurance plans or offered as stand-alone dental plans. Small businesses (those with 50 or fewer employees) and non-grandfathered plans outside the exchanges must also offer pediatric dental and vision benefits. As EHBs, pediatric dental and vision benefits will no longer be subject to annual or lifetime limits.

Click here for “10 Essential Facts About the Affordable Care Act, Dental and Vision Benefits.”

However, how it helps depends on where you live.

If the benefits are not embedded on state and federal exchange plans and are instead sold separately, there will be no requirement to purchase them. Because EHBs vary based on the benchmark plan selected by each exchange, pediatric dental and vision benefits will vary.

Read “Access to Dental Coverage Through the Affordable Care Act” to learn more about access and affordability when it comes to dental care and the Affordable Care Act.

An estimated 8.7 million children will gain some form of dental benefits by 2018 as a result of the Affordable Care Act, according to the American Dental Association, about one-third through Medicaid and two-thirds through private coverage. About 4.5 million adults will “gain extensive dental benefits through Medicaid” and about 800,000 will gain private dental benefits through health insurance exchanges.

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