Obamacare Dental Coverage
Although many health services are covered by Obamacare, dental coverage is left off the table, and pediatric orthodontia will be affected as well. People are still going to need pediatric dental services but you may need to prepare for cost shifting if your kids need braces or other dental services. According to Evelyn Ireland, Executive Director of the National Association of Dental Plans, “Orthodontia is one of the big coverage differences that may occur for pediatric dental.”
Ireland states, “Pediatric dental in the proposed rules is defined as any enrollee up to age 19, so the way PPACA is structured, pediatric dental is a benefit that is described as part of the essential health benefits that will be offered in the small group and individual market. Of course, the small group includes exchanges.”
In effect, one of the biggest changes to pediatric dental coverage may entail how the categories of orthodontic needs are addressed. Because pediatric dental doesn’t include cosmetic ortho, things get a little confusing because the PPACA doesn’t actually define what’s included as “cosmetic ortho”. Although the original definition states that it includes medically necessary ortho, the government has yet to clarify specifics under Obamacare dental coverage.
Sound confusing? Try to think about it this way. If 70% of people who currently get reimbursed for ortho now don’t get reimbursed, that creates a huge shift in coverage. Between birth and the age of 20, 18-19% of all children have some sort of orthodontic procedure done, so with these changes now only around 1/3 of those kids would be covered. All the rest wouldn’t have Obamacare dental coverage under the Obamacare Essential Coverage Plan. That’s going to radically change the paradigm for expenses to not only you but for dentists as well.
The problem comes down to this; the existing system can’t really sustain any major cost shifting due to its already complicated and fragile makeup. If the government increases taxes on medical devices such as braces, the cost gets passed along to everyone, which of course usually doesn’t bode well for the common consumer.
With the headlong pursuit of mandated health care, one benefit has been largely left to fend for itself. Dental care has been treated by the health care industry for many years as that red-headed stepchild that parents are not sure how to deal with or where to put them. Because the primary issue with government and commercial insurance has been focused on primary medical and major medical care, the dental business has been trying in earnest to keep up, but seemingly not able to keep pace.
This is a situation that troubles a lot of public health advocates. About 33 million Americans live in areas where there aren’t enough dentists to meet oral health care needs. Research has linked poor oral health to increased use of emergency services and hospitals, and higher risk for diabetes and heart and respiratory diseases.
For the most part, thanks to the lack of Obamacare dental coverage (with the exception of a pediatric dental mandate), the vast majority of people who have dental coverage are going to need help come 2014.
Currently, adult and children’s dental plans are mostly sold as group plans offered by employers. These dental plans are separate from medical plans. As one of the 10 essential health benefits under the PPACA, pediatric dental benefits will be part of medical plans sold outside of the insurance exchanges.
Pediatric dental plans also will be sold in insurance exchanges, both packaged with medical plans and as standalone dental plans—choices include pediatric dental embedded in the plan, as a rider, or as a standalone plan
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