AAPD Expert Helps Consumers Understand ACA Pediatric Oral Health Care Coverage

November 21, 2013 02:51 PM
 The Philadelphia Inquirer’s Healthy Kids blog featured Dr. Paul Reggiardo, AAPD national spokesperson, in a Q&A to help inform consumers about the Affordable Care Act and kids’ dental benefits. Pediatric dental benefits are now considered to be one of 10 "essential benefits" plans must provide. With that said, children will either have pediatric dental benefits included in a medical plan package or there will be an option to purchase these benefits separately. That is why Reggiardo highly recommends that parents and caregivers should ask several questions when selecting a health insurance plan and dental benefits for their family. 

According to the blog, on a national scale—this new provision could mean 8.7 million children currently lacking dental benefits could gain coverage through the ACA by 2018. This new accessibility to dental care has the opportunity to help curb the staggering statistics provided by The Centers for Disease Control and Prevention, which shows that tooth decay is the number one chronic infectious disease among children in the U.S., affecting 42 percent of children aged 2 to 11 years old.

Are pediatric dental benefits always included in the insurance exchanges?

Dr. Reggiardo: While pediatric dental benefits for your child are always offered in the state insurance exchanges, they are not always included and may be marketed as a separate stand-alone dental plan. Be sure that dental coverage is part of your child’s health insurance package.

What are the differences between pediatric dental benefits embedded in my health insurance plan, a bundled plan that includes pediatric dental benefits and a stand-alone pediatric dental benefit plan?

With a dental plan embedded in a medical plan, the medical carrier assumes all risks and liabilities of covering the dental benefits and there is one premium. This coverage may have a combined medical and dental deductible. With these plans, it is important to understand that dental expenses may not be covered until the high common deductible is satisfied.

A bundled dental plan is sold with medical coverage, but there are two separate policies. The dental coverage could be administered by the medical insurance carrier or by a separate dental carrier. With bundled dental coverage, there is a common premium, but separate deductibles and out-of-pocket maximums are not affected by the medical coverage.

A stand-alone dental plan is one that is sold separately from medical coverage, and therefore always has separate premiums and deductibles that are specifically for the dental benefits. Stand-alone dental plans allow buyers to select independently of their children’s medical coverage the type of dental plan and the provider network which most closely matches their desires.  

To continue reading the interview in its entirety, visit http://www.philly.com/philly/blogs/healthy_kids/ACA-and-kids-dental-benefit-What-do-I-need-to-know.html


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