Under the Affordable Care Act (ACA), dental coverage is treated differently for adults and children. Routine dental care for adults is not one of the essential health benefits required for a plan to be a Qualified Health Plan. For children, those younger than 19, dental care is a pediatric service that must be covered as an essential benefit.
Adult dental coverage
Job-based insurance — Routine dental care, such as exams and cleanings, were at one time regularly included in comprehensive health plans. Skyrocketing health insurance costs over the past decade have forced many employers to cut back on the health benefits they provide for their employees. Many may have dropped dental coverage. If you have health insurance through your job, check your policy documents to determine if dental services are covered. Your employer may offer dental insurance as a standalone policy. Generally, you would pay an additional amount for a standalone dental policy.
Health insurance marketplace plans — Health plans offered in the health insurance marketplace may include dental coverage, but plans in the exchanges are not required to offer adult dental care. When shopping for a policy in the exchange, you will be able to compare coverages and costs to determine which policy best meets your needs. In many states, standalone dental policies are available. Some states, such as New York, plan to add separate dental plans, but they are not available for the 2014 open enrollment period.
Medicaid — If you are insured through your state’s Medicaid program, your plan may have some dental benefits. Most states offer coverage for emergency dental services in their Medicaid programs. A few offer preventive services for adults with expanded provisions for pregnant women.
Child dental coverage
Regular dental exams for children are included in the package of essential health benefits required by the ACA of all new health insurance policies. Plans issued before the health reform law was implemented may have grandfathered status and might not offer dental care for children. Both Medicaid and the Children’s Health Insurance Program (CHIP) cover pediatric dental care. These services must include pain and infection relief, tooth restoration, exams and cleanings.
This article was written by Gillian Burdett. Gillian is a freelance writer covering all things home and living. Her work can be found on Examiner.com.