The Children's Dental Health Project's blog
N.Y. Times examines the dental "gap" in ACA
A New York Times article examines the implementation of the Affordable Care Act's (ACA) dental benefit and how the reality differs from what the law's supporters had intended. The Times identifies two problems with the rules that were issued to implement the ACA:
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. ... Stand-alone dental plans don’t qualify for subsidies, as do medical plans on the exchange.
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.
The Times notes that state insurance marketplaces in at least three states (Kentucky, Nevada and Washington) require parents to purchase a children's dental benefits when they buy medical coverage -- even if they are sold separately. However, parents may qualify for a financial subsidy for buying medical insurance, but they do not receive a subsidy for the separate purchase of a dental plan. The article quoted Colin Reusch, a senior policy analyst at the Children’s Dental Health Project:
“We want to make sure dental coverage is not only essential but affordable. Given some of the complicating factors, we haven’t been convinced yet that we want to require families to purchase.”
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