Coverage Gap in ACA Affects Children

A coverage gap in the Affordable Care Act (ACA) means that many children will not be eligible for dental coverage, which was mandated as one of the 10 essential health benefits for adequate health insurance. While still offered in either embedded or stand-alone insurance plans, the plan offerings vary statewide and many families are not eligible for subsidies.

“The lack of a subsidy could have an influence on the purchase of coverage,” said Evelyn Ireland, the executive director of the National Association of Dental Plans. “All of our organizations will push for resolution by early next year.”

Without a mandate or requirement to include dental, policies will be less affordable. Senator Debbie Stabenow (D-MI) suggested that exchange plans have failed many families’ expectations. “Congress has made clear that the cost of dental care coverage for children, whether through a family’s stand-alone dental plan or as part of an overall medical insurance plan, should be included in calculating the amount of tax credit a family receives to help buy affordable insurance,” she said.

Experts hope that increasing the integration of embedded health plans will close the gap. When embedded, the dental plans are eligible for the subsidy.

“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.”

Adult dental is not covered under the ACA. A survey from WellPoint found that while Americans 45 years and older value dental coverage benefits, only 4 in 10 have dental insurance from an employer, private, or supplemental plan. Of the top 10 costliest medical services not covered by insurance, adult dental procedures placed 10th.

Kev Coleman, head of research and data at HealthPocket, said, “Given that most of the medical service exclusions within the Top 10 list can continue after the implementation of health reform, it is vital that consumers closely examine their benefit coverage options when they shop for health insurance.”

Around the Web

A Gap in the Affordable Care Act [NY Times]

A WellPoint Survey Finds Baby Boomers Want Information on Dental Insurance [Wellpoint]

10 Services Insurers are Least Likely to Cover [Fierce Health Payer]