Thursday, December 19, 2013

Let’s Keep the Spotlight on Pediatric Dental

By: Fay Donohue
Most of the media coverage around the Affordable Care Act (ACA) recently has focused on the problems with and marketplace websites, so I was happy to read an article in the New York Times this week about pediatric dental benefits. I’ve written before about pediatric dental; Catherine Saint Louis’ New York Times article highlights both why it is so important that all children have access to dental benefits and what steps we need to take to make that a reality.

In the United States, children miss 52 million school hours per year because of dental problems. Dental disease is the most common chronic disease of childhood - five times more common than asthma. The ACA provides an unprecedented opportunity to improve children’s access to dental care. However, the way it is being implemented is creating challenges that may prevent it from achieving that goal. Currently, families purchasing insurance outside of the new marketplaces will be required to purchase pediatric dental benefits. The rules for purchases through the marketplaces do not require you to include dental insurance in your “shopping cart” when you “check out.”

This discrepancy means that if people choose not to buy dental insurance, millions of children may continue to go without necessary dental benefits. This was clearly not the intent of the law. We believe essential benefits should be essential in all circumstances.

The New York Times article also talks about the different ways you can purchase dental benefits through the marketplaces – either through an option that includes or “embeds” your dental benefits in your health insurance plan or as a separate plan from your medical benefits. Ninety-eight percent of Americans with employer-sponsored dental coverage today get their benefits from a standalone plan.

Before the ACA, if your employer didn’t offer dental coverage, it was difficult to shop around for a dental plan on your own. Now, the marketplaces provide a one-stop shop – technical glitches aside – for people to compare plans and purchase dental coverage.

One key point that was not made in the New York Times article is that people are buying dental plans through the marketplaces. In fact, early reports out of some states show that their first marketplace enrollments on 10/1/13 were for dental plans and in at least one state more people are purchasing dental plans than medical!

We think people need choices and that may mean standalone or embedded dental benefits. However, dental benefits embedded in medical plans could expose buyers to a less than generous dental benefit and greater upfront costs for basic services like cleanings, sealants, fluoride, and filings -- especially if it is the only option on the marketplace. It is also important that there be the option of plans that offer adult dental as well as pediatric dental benefits. Selection of plans and benefits is dependent on a person’s unique needs. That’s why there need to be knowledgeable ACA navigators to assist new buyers.

Additionally, there are tax benefits available to families who cannot afford to purchase health insurance. If you qualify for a subsidy, it will first be applied to the cost of the premium for your health plan. Then, if there is money left over, it will be applied to the premium for your dental plan. This formula could leave millions of families unable to afford dental insurance because there will be few, if any, dollars available to cover pediatric dental. The federal government can make a simple adjustment to this formula to ensure that low-income families have the financial assistance they need to purchase high-quality dental coverage. Unfortunately, other important priorities have taken the focus away from pediatric dental health. As the New York Times article states, “kids’ dental shouldn’t be the stepchild of plans the exchanges are offering.”

At DentaQuest, we are committed to working with our colleagues, the federal government, members of Congress, and advocacy organizations to develop short-term and long-term solutions to ensure that all children have access to high-quality, affordable dental care.