Access to dental coverage through the Affordable Care Act

How does the Affordable Care Act affect dental insurance? Photo: Dentistry and Affordable Care

WASHINGTON, May 15, 2013 ― The theory behind the Affordable Care Act (ACA) is that it will make healthcare more affordable and available to everyone, including those seeking dental care. For many families already under a healthcare plan, for instance those with insurance through an employer, the ACA will have little to no effect on them or their coverage. Where the act is meant to have its biggest impact is in those situations where it was difficult or impossible for families to obtain care.

How can families get dental help through the Affordable Care Act?

There are two main ways to achieve help through the ACA, and they are through either the small group plan or the individual care plan. These plans are both meant for those who could not previously achieve healthcare on their own for either themselves or their families. This is particularly important for those families with young children, as it is paramount to gain healthcare for them as soon as possible. Care for children is set as one of the “essential health benefits” of the plan and is now a mandatory element of coverage.

Is dental care required under ACA?

At this time, dental coverage is not a requirement at the Federal level of this plan, though some states include it. California is one of those states, and they are proposing a requirement for families to purchase dental coverage as a standalone policy if it is not included in the benefits package of their regular healthcare coverage. Dental policies are not subject to most ACA provisions; only pediatric dental benefits are part of the Essential Health Benefit Packages, which require individuals and small employers to provide pediatric dental coverage.

There are many concerns for the affordability of this standalone coverage, partly due to the fact the ACA requires that companies lift the annual and lifetime limits on coverage. This might result in insurance providers raising premiums to cover these extra costs to them. Making these plans affordable for families will be up to the states and poses a challenging task.

What are the state by state requirements?

Each state is required to have an “exchange” where consumers can shop for healthcare coverage. These exchanges are going to be designed in a way to cause insurance companies to compete with one another to provide coverage at affordable rates while still providing the essential health benefits. These exchanges also are the method by which some families may qualify for federal subsidies to assist with the cost of healthcare.

All in all the ACA has been designed to make obtaining healthcare easier for those who had difficulty doing it previously, and one benefit will be to more reliably provide dental coverage to families.

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Ali Forghani, DDS

My name is Dr Ali Reza Forghani, and I currently run the Modern Smiles Dental Practice in Rockville, Maryland.  I graduated from New York University College of Dentistry, after receiving my Bachelor of Science degree from the University of Maryland.  My aim is to provide comprehensive dental care for all of my patients, and I believe that education and the use of modern methods and technologies is the best way to achieve this.


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