Affordable Care Act Dental Coverage
Dental insurance, for the most part, isn't covered under ObamaCare (the Affordable Care Act). However, children's dental coverage is a required benefit included on all ACA compliant plans. Although dental isn't a big part of the Affordable Care Act it is certainly an important aspect of health and wellness and therefore we thought it would be appropriate to discuss dentistry facts, dental insurance and how the new healthcare law affects dental coverage.
What is Dental Insurance?
Just like health insurance, dental insurance is designed to pay a portion of the costs associated with dental care in return for a monthly premium. There are three common types of dental insurance (ref: http://en.wikipedia.org/wiki/Dental_insurance):
Indemnity Dental Insurance Plan: This plan may be helpful when you want to stay with your dentist and he/she does not participate in a dental network. By the very nature of this plan the insurance company generally pays the dentist a percentage of your services according to the policy you purchased. In addition you will want to review the co-payment requirements, waiting periods, stated deductible, annual limitations, graduated percentage scales based on the type of procedure and/or length of time you have owned the policy prior to starting your dental work.
Dental Health Managed Organization (DHMO): When a dentist signs a contract with a dental insurance company that provider agrees to accept an insurance fee schedule and give their customers a reduced cost for services as an In-Network Provider. Many DHMO insurance plans have little or no waiting periods, no annual maximum benefit limitations, while covering major dental work near the start of the policy period. This plan is sometimes purchased to help defray the high cost of the dental procedures. Some dental insurance plans offer free semi-annual preventative treatment. Fillings, crowns, implants and dentures may have various limitations.
Participating Provider Network (PPO). Depending on your specific plan, the PPO works similar to a DHMO while using an In-Network facility. However, it allows you to use an Out-of-Network or Non-Participating Provider. Any difference of fees will become the financial responsibility of the patient unless otherwise specified in your dental policy. As noted, some dental insurance plans may have an annual maximum benefit limit. Thus, once the annual maximum benefit is exhausted any additional treatments may become the patient's responsibility. Each year that annual maximum is reissued. The reissued date may vary as a calendar year, company fiscal year, or date of enrollment based on your specific plan.
Is Dental Coverage Required Under the ACA?
Yes, for children but not adults. After Jan. 1, 2014, all individual and small group market plans – both inside and outside the exchange – must be certified as "qualified health plans" except for stand-alone dental plans. QHPs must provide all "essential health benefits". Pediatric oral health services are included in the 10-category EHB package and must be offered.