A Gap in the Affordable Care Act - Until the new health care law, separate medical and dental plans had been the status quo. Now even some insurers are wondering whether this benefit should be offered separately.

From The New York Times:

The Affordable Care Act mandated that insurers cover dental care for children. Indeed, it was one of the 10 essential health benefits meant to set the bar for adequate health insurance.

But pediatric dental care is handled differently from coverage of other essential benefits on federal and state exchanges. These plans are often sold separately from medical insurance, and dental coverage for children is optional. People shopping on the exchanges are not required to buy it and do not receive financial support for buying it.
      

Now experts are warning that the flawed implementation of this benefit on the exchanges could leave millions of children without access to dental care.

      

“It’s letting kids down in my mind, and it is clearly inconsistent with congressional intent,” said Dr. Paul Reggiardo, the chair of the American Academy of Pediatric Dentistry’s Council on Dental Benefit Programs. “The intent was to include all children. Now it only includes some.”

      

Tooth decay is the most common chronic childhood disease. Fourteen percent of children age 6 to 19 have untreated cavities, which can cause pain and, in rare cases, death. But the percentage of uninsured children who see a dentist annually declined to 25.2 percent in 2011 from 31.5 percent in 2003, according to the American Dental Association.

      

Had pediatric dental insurance remained a mandatory purchase on the new insurance exchanges, as originally envisioned, roughly three million children would have gained coverage this way by 2018, according to an analysis by the dental association. Pediatric dental coverage “has gone from a guarantee to a quote-unquote guarantee,” said Andrew Snyder, a program manager at the National Academy for State Health Policy.

      

On the state and federal exchanges, children’s dental coverage generally comes in two forms. It may be “embedded” in medical insurance plans or sold separately in “stand-alone” plans.

      

Both options are not available on every exchange, though they often coexist. State exchanges in New York and Massachusetts, and most of those run by the federal government, offer a choice of health plans with or without embedded pediatric dental benefits and stand-alone dental plans.

      

Generally, it is the stand-alone dental plans that worry policy experts and deter consumers on the exchanges.

 

More than a dozen senators and several advocacy groups representing dentists, insurers and consumers have asked the Internal Revenue Service to revisit its decision to deny subsidies to purchasers of stand-alone dental plans for children.

 

Stand-alone dental plans are also exempted from the law’s limits on out-of-pocket expenses. While out-of-pocket maximums for health plans are capped at $12,700 per family, stand-alone dental plans may have separate maximums of $700 per child to $1,400 for two or more children. On Dec. 2, the Health and Human Services Department proposed new lower annual limits — $300 for one child and $400 for two or more — for all marketplaces in 2015. The public comment period lasts until Dec. 26.

      

Separate treatment of dental insurance on the exchanges has had another unforeseen consequence: In most states, there’s no mandate that parents buy dental insurance for their children at all.

 

Officials at the Connecticut exchange dodged the problem by requiring all medical plans to provide coverage of children’s dental care. “By embedding it into the plans, we could guarantee it would be purchased,” said Chad Brooker, policy and legal analyst at Access Health CT.

 

At least three exchanges — in Kentucky, Nevada and Washington — require parents to buy pediatric dental benefits, even if they are sold separately, when buying medical insurance. Without the requirement, the stand-alone dental policies would be less affordable, said Dr. John A. Thompson, a Kentucky dentist on the state exchange board.

 

“We’ve spread the risk over a larger population,” he said, “and it drives the cost down significantly because not just parents of children with high dental needs are covered.”

      

But that means that parents who buy medical insurance on the Kentucky exchange might also end up buying a second policy that does not qualify for additional financial supports. Some experts are reluctant to recommend that approach.

 

“We want to make sure dental coverage is not only essential but affordable,” said Colin Reusch, the senior policy analyst at the Children’s Dental Health Project. “Given some of the complicating factors, we haven’t been convinced yet that we want to require families to purchase.”

 

Until the new health care law, separate medical and dental plans had been the status quo. Now even some insurers are wondering whether this benefit should be offered separately. Dennis Spain, the chief dental officer of Nevada Dental Benefits, suggested that medical plans might find savings in partnering with dental plans that pay for preventive services.

 

“Medical plans in Nevada pay for anesthesia for kids who need a massive amount of cavity work in the operating room,” Mr. Spain said. “What if I came along and said, ‘I’ll cut the incidence of early childhood cavities in half’? What’s that worth to a medical plan?”

      

California is revisiting the pediatric dental options on the state exchange in 2015. Some state advocates argue that embedded plans, which would put an end to the medical-dental divide, are the best way forward.

      

“Kids will have dental care integrated into medical care, and families will have cost sharing the Affordable Care Act is supposed to provide,” said Kathleen Hamilton, the director of governmental affairs at the Children’s Partnership in Sacramento.

      

“Kids’ dental shouldn’t be the stepchild of plans the exchanges are offering.”