PAYDAY Workforce Solutions Blog

Pediatric Dental Care and the ACA

On Jun 16, 2014

According to the American Academy of Pediatric Dentists, more than half of U.S. children will have cavities by age 5. Dental cavities are manageable when treated promptly but cause or contribute to big health problems when left without treatment, including obesity, diabetes, and heart disease.

Effects of Neglecting Dental Care

The chairman of the American Academy of Pediatric Dentistry's Council on Dental Benefit Programs, Dr. Paul Reggiardo, reports that early dental problems affect learning, social interaction, and ability to eat.

Most employee benefits plans include dental coverage, and the Affordable Care Act has a provision for pediatric dental care as well. But the complexity of dental coverage, premiums, and deductibles has made it a highly under-utilized benefit.

Pediatric Dental Coverage Under the ACA

Parents can get pediatric dental insurance in the exchanges in two ways, either as part of a family medical plan or as a separate, stand-alone policy.

Although the American Dental Association reported that 10 million children didn’t have dental insurance in 2011, only 63,448 children in 36 states received the coverage with the ACA stand-alone option in the 2014 enrollment period. How many received coverage through a family medical plan is still unknown.

Those watching the ACA implementation think the reason pediatric dental coverage isn’t as widespread as the need for it includes the complicated nature of insurance and the fact that there’s not a subsidy for it or a penalty for not buying it. Additionally, the American Dental Association reports that less than one third of medical plans on the exchanges included pediatric dental benefits.

It’s Complicated

Since not all medical plans on the exchanges included pediatric dental benefits, parents who chose medical plans without dental for either coverage, cost, or availability reasons faced the additional cost of a separate dental plan.

Dental plans cover preventive care and services including fillings, sealants and medically necessary orthodontia, although some states don’t offer orthodontia coverage. Prices and deductibles for dental plans vary by options and geographic locations, so costs and coverage vary greatly. The nationwide average for a low-option plan was $21 and a high-option plan averaged $27.

Subsidies and lack of support in choosing dental plans make it harder for parents to figure out the best coverage and costs they can afford. How deductibles work can be particularly confusing, since if the coverage is part of a medical plan, dental may not be covered until the medical deductible is met, and out-of-pocket limits are different than for stand-alone dental plans.

Experts like Mark Vujicic, vice president of the American Dental Associations Health Policy Institute, are looking at the need for expanding dental access for kids under the Affordable Care Act. If pediatric dental care is one of the health laws’ essential benefits, it needs to be better understood and truly affordable to be well utilized.

Contact PAYDAY for solutions regarding pediatric dental coverage under the ACA.

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