Clarifying NPR story on ACA dental coverage

By the CDHP team

Update: Veteran NPR reporter Julie Rovner filed a new story today (Jan. 9) on the pediatric dental benefit, noting "These rules are so confusing they even tripped me up." We understand!

This morning (Jan. 6, 2014), NPR ran a story attempting to answer a number of listener questions about the Affordable Care Act (ACA), including whether the law requires the purchase of dental coverage. Unfortunately, NPR's answer oversimplified how dental benefits for children are made available under the ACA.

NPR's health reporter was asked whether the ACA requires all family members to have dental coverage. She replied that “only dental coverage for children is among the required benefits,” further clarified that consumers can purchase child-only dental benefits and added: “In fact, any plan on the exchange will cover [a child’s] dental.” While it’s true that only dental benefits for children up to age 19 are part of ACA’s essential health benefits and that child-only plans must be available on the new health insurance marketplaces (exchanges), pediatric dental coverage is not necessarily required to be purchased. In addition, dental benefits for children certainly aren’t covered by all plans sold on state exchanges.

As we point out in our FAQ, pediatric dental coverage is often sold through a stand-alone dental plan, separate from a family or child’s health coverage. In marketplaces where it is sold separately, health plans are not required to cover pediatric dental though they may still choose to do so. But unless state policy dictates otherwise, the purchase of stand-alone pediatric dental coverage is not required under federal law. Currently, only Kentucky, Nevada and Washington have such a requirement.

Additionally, in some states, like Washington and California, pediatric dental coverage must be sold separately, making it impossible for eligible families to receive a tax credit for all of their coverage.

NPR is correct that dental coverage for adults is completely optional; plans do not have to offer it and there’s no requirement to purchase it. And while adult dental coverage may be available through some plans in the marketplaces, it’s not part of the ACA’s essential health benefits and therefore not supported by any subsidies or consumer protections.

So, to sum up the reality, pediatric dental coverage must be offered in the new health insurance marketplaces but isn’t necessarily a required benefit if it’s sold as a separate plan. Adult dental coverage may be available if plans choose to offer it. And there’s no guarantee in most states that pediatric dental will be included in all health plans.


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