The Children's Dental Health Project's blog
Washington State's ACA dental options to expand
Children’s dental coverage is once again an issue of debate in Washington State, making it the latest state to reconsider how dental benefits will be offered in its health insurance marketplace for 2015. Current state policy requires that pediatric dental coverage be offered only through stand-alone dental plans inside of the Washington Health Benefit Exchange, while health plans in the small-group and individual insurance markets outside of the exchange must embed dental coverage for kids in their products. But a new proposal from the Office of the Insurance Commissioner would change this, allowing health plans inside Washington's exchange to include pediatric dental benefits in their insurance packages.
Advocates for maintaining the stand-alone-only approach inside the exchange assert that dental benefits embedded in health plans are “illusory,” pointing to high deductibles that require families to pay out-of-pocket for basic dental services. That may be true with some health plans, but it is by no means universal. In fact, while dental benefit structures vary from plan to plan and state to state, there is evidence that health plans increasingly recognize the importance and value of oral health services.
As states like Washington reconsider their approach to offering pediatric dental coverage in and outside of the new health insurance marketplaces, transparency should be a priority.
For example, some health plans in the Washington, D.C. marketplace set a separate, lower deductible for children’s dental benefits. In Connecticut, where all marketplace health plans offer children’s dental coverage, silver, gold, and platinum plans completely exempt dental benefits for kids from the deductible. Similarly, California has decided not to apply any deductible to children’s dental coverage in health plans for 2015.
However, as I have previously noted, in many marketplaces, it’s not so easy to determine how deductibles and cost-sharing apply to children’s dental coverage embedded in health plans. As states like Washington reconsider their approach to offering pediatric dental coverage in and outside of the new health insurance marketplaces, transparency should be a priority. Health plans should be required to disclose whether dental benefits are subject to the full medical deductible and should make clear to consumers how those services are covered. Only then will we be able to make any definitive statements comparing the value of children’s dental benefits between health plans and stand-alone dental plans.
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