The pediatric essential health benefits called for in the Patient Protection and Affordable Care Act (ACA) should be allowed to stand alone or alongside all the ACA's essential health benefits, whether inside or outside a health exchange.
This important option -- which lets consumers choose their dental plan rather than be forced to accept dental benefits embedded in a medical policy -- is critical to ensuring Americans gain access to best-in-class dental benefits that suit their needs and budgets. Studies show that people with dental insurance are nearly twice as likely to visit their dentist as those without, which is why we need the rules that affect dental benefits in and out of exchanges to be simplified.
The authors of the ACA steered away from making dental coverage an essential health benefit for adults, instead designating it only for children age 19 and younger. Pediatric and adult dental plans (that is family dental plans) are available on most exchanges either as standalone policies or combined with medical. A few states such as California require small-group and individual medical plans to always embed children's dental benefits, even for individuals and childless couples who pay for these benefits but are not able to use them.
Outside exchanges, the ACA inexplicably restricts the offer of standalone dental policies for children in the individual and small-group markets. It does this in ways dentists, brokers, health plans, and dental plans are hard-pressed to understand or explain. Why are rules surrounding dental benefits not the same inside and outside a health exchange? An unintended drafting error in the final version of the ACA failed to pick up language describing dental on the inside of exchanges and bring them over to the outside. This is a problem that needs fixing!
Fortunately, the "fix" is in -- or will be if Congress passes a bipartisan sponsored bill called the Aligning Children's Dental Coverage Act.
The bill, HR 3463, co-sponsored by Reps. Morgan Griffith (R-VA) and Diana DeGette (D-CO), will allow -- but not require -- medical plans in the outside exchange individual and small-group markets to omit pediatric dental from their policies when standalone pediatric dental policies are available. This aligns on- and off-exchange rules and allows consumers to choose the pediatric dental plan best-suited to their children's needs, but still preserves all the required dental benefits that meet ACA coverage standards.
On June 10, 2016, the House Committee on Energy and Commerce's subcommittee on health held a hearing on five ACA-related bills, including HR 3463. The chairman of the subcommittee, Joe Pitts (R-PA), actually called out HR 3463 at the hearing as the only truly bipartisan bill in the lot.
When dental benefits are embedded with medical benefits, the pediatric dental benefit is often subject to a high, combined medical-dental deductible, causing families to spend thousands of dollars before even diagnostic, preventive, and basic services are covered. This leads many parents to forgo the dental work their children need, even when they thought they had coverage when they purchased these policies.
The bill addresses this, because it will make more available standalone dental plans that almost always offer first-dollar coverage for diagnostic and preventive care. When affordability is the barrier to coverage, no one wins.
Please contact your member of Congress and ask them to support HR 3463, the Aligning Children's Dental Coverage Act, to improve dental benefits for children and the pockets of their parents. Urge your congressperson to put his or her name on this bill to join a growing chorus of legislators from both parties who are putting aside their partisan differences to cosponsor the legislation.
Album is vice president of public and government affairs for Delta Dental of California, Delta Dental Insurance Company, Delta Dental of New York, Delta Dental of Pennsylvania, and other affiliated companies.
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