By:
Fay Donohue
Most
of the media coverage around the Affordable Care Act (ACA) recently has focused
on the problems with Healthcare.gov and marketplace websites, so I was happy to
read an article in the New York Times this week about pediatric dental
benefits. I’ve written before about pediatric dental; Catherine Saint
Louis’ New York Times article
highlights both why it is so important that all children have access to dental
benefits and what steps we need to take to make that a reality.
In
the United States, children miss 52 million school hours per year because of
dental problems. Dental disease is the most common chronic disease of childhood
- five times more common than asthma. The ACA provides an unprecedented
opportunity to improve children’s access to dental care. However, the way it is
being implemented is creating challenges that may prevent it from achieving
that goal. Currently, families purchasing insurance outside of the new
marketplaces will be required to purchase pediatric dental benefits. The rules
for purchases through the marketplaces do not require you to include dental
insurance in your “shopping cart” when you “check out.”
This
discrepancy means that if people choose not to buy dental insurance, millions
of children may continue to go without necessary dental benefits. This was
clearly not the intent of the law. We believe essential benefits should be
essential in all circumstances.
The
New York Times article also talks
about the different ways you can purchase dental benefits through the
marketplaces – either through an option that includes or “embeds” your dental
benefits in your health insurance plan or as a separate plan from your medical
benefits. Ninety-eight percent of Americans with employer-sponsored dental
coverage today get their benefits from a standalone plan.
Before
the ACA, if your employer didn’t offer dental coverage, it was difficult to
shop around for a dental plan on your own. Now, the marketplaces provide a
one-stop shop – technical glitches aside – for people to compare plans and
purchase dental coverage.
One key point that was not made in the New York Times article is that people
are buying dental plans through the marketplaces. In fact, early reports out of
some states show that their first marketplace enrollments on 10/1/13 were for
dental plans and in at least one state more people are purchasing dental plans
than medical!
We
think people need choices and that may mean standalone or embedded dental
benefits. However, dental benefits embedded in medical plans could expose
buyers to a less than generous dental benefit and greater upfront costs for
basic services like cleanings, sealants, fluoride, and filings -- especially if
it is the only option on the marketplace. It is also important that there be
the option of plans that offer adult dental as well as pediatric dental
benefits. Selection of plans and benefits is dependent on a person’s unique
needs. That’s why there need to be knowledgeable ACA navigators to assist new
buyers.
Additionally,
there are tax benefits available to families who cannot afford to purchase
health insurance. If you qualify for a subsidy, it will first be applied to the
cost of the premium for your health plan. Then, if there is money left over, it
will be applied to the premium for your dental plan. This formula could leave
millions of families unable to afford dental insurance because there will be
few, if any, dollars available to cover pediatric dental. The federal
government can make a simple adjustment to this formula to ensure that
low-income families have the financial assistance they need to purchase
high-quality dental coverage. Unfortunately, other important priorities have
taken the focus away from pediatric dental health. As the New York Times article states, “kids’ dental shouldn’t be the
stepchild of plans the exchanges are offering.”
At
DentaQuest, we are committed to working with our colleagues, the federal
government, members of Congress, and advocacy organizations to develop
short-term and long-term solutions to ensure that all children have access to
high-quality, affordable dental care.