With the Affordable Care Act now in effect, parents across the country want to know how the new law will change health care coverage for their kids.
One important change mandated by the law intends to improve dental care coverage for children, a provision brought on by the unfortunate death of 12-year old Deamonte Driver, a young man from Maryland who died due to a bacterial infection that spread to his brain from an abscessed tooth.
Advocates in Washington who championed for better dental care for kids successfully pushed for the ACA to include provisions on vision and dental services as part of the law’s 10 categories of essential benefits.
To mark the launch of Cover Oregon’s new health-care marketplace, here are a few questions and answers from your choice for cosmetic dentistry in Sandy, regarding purchasing dental coverage for your kids.
Does the ACA require parents to purchase pediatric dental care when purchasing insurance through an exchange?
Federal law does not require parents to purchase pediatric dental care when purchasing a health plan. However, state laws vary regarding coverage requirements. While Oregon does not require parents to purchase a separate dental plan for their kids, Washington state does mandate dental coverage for children. Most basic dental plans will cover visits to the dentist for basic preventative services, such as fillings, x-rays, dental cleanings, and any medically necessary orthodontics.
Do health insurance providers typically not include dental as part of comprehensive health insurance?
In the majority of cases, dental benefits must be purchased separately from medical plans offered in the current market. The National Association of Dental Plans reports 99 percent of dental benefits are sold under a separate policy from medical coverage. Under Cover Oregon, medical carries offering coverage can elect whether to include pediatric dental care in their comprehensive health plans. Plans not providing dental coverage must clearly state the lack of dental care in the policy details. Cover Oregon will make available stand-alone dental plans as a separate offer once you have selected a policy in which to enroll.
How many kids will the ACA benefit?
Approximately 8.7 million children stand to benefit from some level of increased benefits by 2018 as a direct result of the ACA. Researchers estimate the law will help to reduce the number of children with dental coverage by nearly 55 percent when compared to 2010 rates, states a report from the American Dental Association. Nearly one-third of these children will receive coverage from their parents’ employer provided insurance, while almost another third will receive coverage through Medicaid. The rest will receive coverage from new policies obtained from health insurance exchanges.
Will parents need to pay out-of-pocket for coverage?
When purchased through a federally managed exchange as a stand-alone policy, pediatric dental coverage can include out-of-pocket expenses that can range from $700 per child to $1,400 per family annually, according to the nonprofit organization Children’s Dental Health Project.
Cover Oregon allows standalone dental issuers to charge a separate “reasonable out of pocket limit” for coverage, which will be $1,000 per member for pediatric dental.
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