I work in an optometrist office. We thought when ACA passed we would see lots of children through this plan. So far none. I call patients insurance plan and they are clueless. How do we find these this coverage for our patients.


All plans must offer pediatric dental, but people can refuse pediatric dental. Some people may not realize that pediatric dental is covered and thus not use it. Often dental is covered as part of a family plan instead of a standalone, this could make it easier to overlook.

Still, it's odd that you wouldn't be seeing more people using their pediatric dental coverage and it's even more odd that an insurer would be confused about this. Rest assured that if a family bought a plan on the marketplace or through an employer and the child is under 19 they have pediatric dental unless they opted out. If anyone has had issues like this please post below.

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Ellen on

Care first is not covering pediatric dental care. The say the subscriber hasn’t signed up for it. The subscriber says they did sign up. Has happened over and over again

Kristin P on

I am finding mixed information specifically about off-exchange requirements for pediatric dental. Reading through the various administrative rules and statements, it seems like off the exchange (in the private marketplace), pediatric dental MUST be offered to the insured unless the insurer has “reasonable assurance” that the insured already has ACA-compliant pediatric dental coverage. However, I see no requirement that the insured actually accept the offer and purchase the coverage through the QHP (or through a standalone plan). However, some sources (including some dental organization websites and dental insurer websites) say the insured buying off-exchange coverage must actually purchase the dental coverage (either through the QHP or a SADP).

Here is an example of a source I found that indicates purchasing the pediatric dental coverage is mandatory when buying off-exchange coverage (https://www.deltadentalins.com/hcx/healthcare-reform-individuals-faq.html).

Are insureds purchasing off the exchange required to buy pediatric dental coverage, or is it optional for them just like it is for purchasers buying on the exchange? If it is required, do you know the source of that rule/requirement?

Thank you.

ObamaCareFacts.com on

It is my understanding that it is always the parent’s right to reject Pediatric dental both on and off exchange. The immediate question that comes to mind is the same as yours, which is, “which Federal register or bit of legislation was this published in?”

It is discussed here: https://www.federalregister.gov/documents/2014/10/01/2014-23323/amendments-to-excepted-benefits (but this isn’t it exactly).

Here is another, although i’m not sure this is exactly what we are looking for either: https://www.federalregister.gov/documents/2015/02/27/2015-03751/patient-protection-and-affordable-care-act-hhs-notice-of-benefit-and-payment-parameters-for-2016

So, I do think I am drawing a blank here. I’ll post if I find it, please if someone has the specific document post it here. Thanks!