The Children's Dental Health Project's blog
Utah dental benefits lack essential services
Families purchasing dental coverage for their children on Utah’s new health insurance marketplace may be surprised to find that they could still end up paying for basic dental services out of their own pockets. The standards set for Utah’s essential health benefits (EHBs) are, by far, the nation’s most limited when it comes to dental benefits for children and adolescents as The Salt Lake Times’ Kirsten Stewart recently highlighted.
Utah only requires that pediatric dental plans cover preventive services under the Affordable Care Act (ACA). With nearly half of all kindergartners experiencing tooth decay, it’s likely that many children receiving coverage through Utah’s marketplace will need more than just basic preventive care to manage their disease and prevent it from progressing further.
Under the ACA, each state selected its own benchmark plan for services that must be covered by plans in the new health insurance marketplaces as well as the existing small group and individual insurance markets. Every state except Utah chose to supplement their benchmark plan with the dental services in either their Children’s Health Insurance Program (CHIP) or the Federal Employee Dental and Vision Insurance Program (FEDVIP), both of which are relatively comprehensive. Utah, however, selected an EHB benchmark that only covers routine dental visits, cleanings, x-rays, fluoride treatments, and sealants. Restorative services like fillings and crowns as well as medically necessary orthodontic care are not required to be covered in Utah’s marketplace plans.
A quick look on HealthCare.gov reveals that monthly premiums for pediatric dental plans available in Utah’s marketplace start at $6 per child. More robust options are available but they are also more expensive. Because consumers tend to gravitate towards the lowest cost options, families may end up purchasing coverage that does not meet the needs of their children.
The standards for basic coverage should reflect what is truly essential. Utah policymakers should revisit their EHB benchmark for 2015. Joining the majority of federally-facilitated marketplaces in using FEDVIP as the benchmark for pediatric dental services would better ensure that all children have access to the care they need.
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