Pediatric dental care new wrinkle in ACA mandates
|By Paula Burkes, The Oklahoman, Oklahoma City|
|McClatchy-Tribune Information Services|
If you buy an insurance plan through the exchange, it's up to you whether you buy pediatric dental coverage -- regardless of whether you have kids. But if you buy a stand-alone dental plan, the most you'll pay, excluding monthly premiums, is
Understanding and implementing the regulations under the Affordable Care Act are confusing enough without the pediatric dental mandate to chew on, some observers say. While providers and dental insurers cautiously support the increased emphasis on children's oral health, they worry parents and others will have a hard time making sense of them.
Employers in the small group market, or those who employ fewer than 50, are scrambling to make sure they're ACA-compliant by offering dental coverage,
"Employers don't have to change their plans and cover dental," Bumps said. "But they have to make the coverage available, and it's up to the employee whether or not they buy it."
Insurers are required to have "reasonable assurance" if someone waives dental coverage that they have the mandated pediatric dental coverage elsewhere, Bumps said. She said
"And if more kids get to the dentist, that's super," Gladden said. Only about half of Oklahomans have dental insurance, and Delta Dental covers about half of those who do, or 800,000, he said.
"But the new mandate is so swishy and flexible that it might be difficult to manage," Gladden said.
Limit opens possible abuse
The potential difficulty comes because on-exchange, stand-alone plans are required to carry a maximum out-of-pocket limit of
"Your dentist could tell you that you need
Meanwhile, the new laws can cause further conflict and confusion, he said, because the pediatric mandate covers only orthodontics or wisdom teeth removal that is "medically necessary," he said. Consumers, he said, mistakenly may think the dental plan they buy covers braces, or removal of their child's wisdom teeth versus only those teeth currently causing problems.
The pediatric dental mandate will be an actuarial experiment, Gladden said. "Only time will tell if people who have low utilization of services will generate enough premium to cover those with higher utilization," he said.
Exchange costs more
Because of the maximum out-of-pocket limit, dental insurance bought inside the exchange costs more than insurance bought outside the exchange or through employers, Gladden said. For example, policies bought on deltadentalok.org run from
As of Friday, reports showed Delta Dental had 60 enrollees in its on-exchange plans, but the company could confirm only six of those, Gladden said. Aside from its own stand-alone plans, Delta Dental will be the administrator of the pediatric dental coverage embedded in the on-exchange health insurance plans of
Moreover, because of the state's increase in per capita income,
Meanwhile, Variety Care nonprofit community health clinic -- which serves some 60,000 uninsured, working poor on a sliding scale basis -- this week broke ground on an 8,000-square-foot,
"It was a wise decision by the ACA to involve oral health care early," Variety Care Chief Executive
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