Why Aren’t Plans Covering Pediatric Dental?

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.

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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.


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!


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

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