By Cathy Miller, Business Writer
As someone who was part of the dental community, I am probably more interested in dental benefits than most insurance agents. While dissection of the health reform law continues on a daily basis, there is little discussion regarding the impact to dental benefits. Let’s look at what provisions in the health reform law apply to dental benefits.
Dental Benefits Tidbits
In this section, when I refer to dental benefits, I mean the types of plans you, as insurance professionals, encounter – individual and group dental benefits. When it comes to specific provisions of the health reform law related to dental benefits, it’s pretty slim pickings.
Similar to many aspects of the health reform debate, there was a division of support in the dental industry. That, combined with the primary focus on providing health coverage for the 45 million uninsured, it is not surprising that dental benefits ranked low in priorities.
Here is a brief summary of provisions specific to dental benefits.
Essential Benefits Package – The health reform law includes an essential benefits package. Part of that package is a mandatory requirement for oral health care benefits for children under the age of 21, referred to as the pediatric dental benefit. Preventive pediatric oral health services include the same ban as other preventive services on out-of-pocket charges.
Stand-Alone Dental Plans – The health reform law allows stand-alone dental plans to participate as part of a health insurance exchange, provided they offer the pediatric dental benefit.The participation of stand-alone dental plans allows health plans in the exchange to exclude oral care for children, since the dental plan offers coverage.
It appears that some of the immediate provisions of health reform do not apply to stand-alone dental plans, including:
- Elimination of annual and lifetime maximums
- Expansion of dependent child definition to age 26
So for those with a stand-alone dental plan, it looks like business as usual – at least in the short-term.
Medicare Advantage Plans – Medicare Advantage plans often offer dental benefits as an added feature. These plans are required to use any rebates to help pay for extra benefits, such as dental benefits.
Cadillac Plans – The 40 percent excise tax that applies in 2018 to Cadillac plans does not include dental plan costs. That was good news for dental plans as early discussions generated a fear that employers would drop dental plans to avoid paying the excise tax.
W-2 Reporting – As noted in Part 2 of our 3-part series on health reform, employers have W-2 reporting requirements, including the aggregate value of dental, medical, vision and Medicare supplemental insurance. NOTE: May 13, 2010 Clarification – dental and vision benefits are included EXCEPT if they are “stand-alone” plans.
The Main Course – Dental Grants and Education
Most of the health reform law related to dental care provides grants and dental health education, including funding for the following:
- An oral health infrastructure managed by the Centers for Disease Control (CDC) to improve dental public health programs
- School-based health clinics and expansion of school-based sealant programs
- A grant program for general, pediatric or public health dentists and dental hygienists
- Demonstration programs for training alternative dental health providers to support underserved communities
The biggest winners in the health reform dental provisions are children. The law strives to provide public or private dental coverage for all children.
No Leftovers for Medicaid
One of the main concerns for the American Dental Association (ADA) was the “failure to properly fund Medicaid.” While the health reform law expanded Medicaid eligibility to 133 percent of the federal poverty level for individuals under age 65, no provisions in the law allow for an adult dental benefit for existing or new enrollees in Medicaid.
Under the current law, dental benefits for adults (age 21 and older) are optional for state Medicaid programs. With the declining economy, the trend saw more states cutting back on dental benefits, some providing for dental emergencies only. Other states provide no adult dental coverage at all – even for dental emergencies.
Another complaint from the ADA was the compensation under Medicaid. The health reform law addressed the issue by requiring Medicaid and the Children Health Insurance Program (CHIP) Payment and Access Commission (MACPAC) to report to Congress on payments to dental and healthcare professionals.
Dental Servings
What the future holds for dental insurance is anyone’s guess – not unlike any form of insurance. For insurance professionals, continuing education on dental and other forms of insurance is an ongoing process, especially with the enactment of the Patient Protection and Affordable Care Act. One thing is certain, there is plenty of change waiting to be served.
Sources: Kaiser Family Foundation, HealthReform.gov, Children’s Dental Health Project, Thomas Library of Congress
Notice of Disclaimer –Cathy Miller and InternetCE are not attorneys and cannot provide legal advice. The information provided is for your general background only, and is not intended to constitute legal advice as to your specific circumstances. We recommend you review legislation with legal counsel.
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Cathy Miller, Business Writer/Consultant has over 30 years of professional writing with a specialty in health care, employee benefits and wellness. Cathy also has an active Life/Accident/Health insurance license. Visit Cathy at her business writing blog, Simply stated business to Keep it simple, clear & uniquely yours.