Buying pediatric dental coverage: a complicated task

By: Colin Reusch

This week marks the opening of the fourth open enrollment period for the health insurance marketplaces created by the Affordable Care Act (ACA). As any reader of our blog knows, pediatric dental coverage is a key component of the benefits package that must be offered on the marketplaces and yet — as CDHP has previously pointed out — purchasing dental coverage under the ACA remains a somewhat complicated task.

Despite some improvements, dental coverage is still largely sold separately from health plans, meaning that families must often shop for multiple products, pay more than one premium, and navigate different sets of rules depending on where they live and what plans are available. And even when families have the option to obtain their children’s dental coverage as part of a health plan, it can be pretty difficult to compare those dental benefits from plan to plan.

It ought to be easier for children to get the full range of essential health benefits, including dental coverage.

We still lack solid enrollment data when it comes to dental coverage in the marketplaces, but we do know that children make up a very small portion of the individuals who are selecting stand-alone dental plans (those sold separately from health plans). And it’s hard to believe that the overly complicated dental coverage landscape isn’t a barrier for families shopping on the marketplaces. Ultimately, it ought to be easier for children to get the full range of essential health benefits, including dental coverage, which is why CDHP has advocated for standardized health plan options that include pediatric dental benefits.

Last month, in comments to the Centers for Medicare & Medicaid Services and in a recent issue brief that we co-authored with Georgetown University’s Center for Children and Families, CDHP has encouraged the Department of Health and Human Services (HHS) to take notes from states like Connecticut and California, and the city of Washington, D.C. — all of which have established standard plan designs for qualified health plans (QHPs) offered on their marketplaces.

CDHP has advocated for standardized health plan options that include pediatric dental benefits.

Not only do these standardized plans include pediatric dental benefits, but they also ensure that cost-sharing and deductibles do not pose a barrier to pediatric dental services which can sometimes be the case with QHPs that choose to include dental coverage.

By applying this same approach in the federally-facilitated marketplaces and requiring that insurers provide appropriately detailed dental benefit information, HHS can maximize pediatric dental enrollment while ensuring that families have options that are both affordable and meaningful.

HHS has already laid out its plan to establish standardized plan options for the federally-facilitated marketplaces but to date, none of those plan designs include pediatric dental coverage, despite its status as an explicitly-outlined “essential health benefit.” CDHP considers this a significant oversight and hopes that the standardized plan approach will be amended for 2018 and beyond to include the full range of pediatric services.

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Did you know?

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Children with poor oral health were nearly 3x more likely to miss school due to dental pain.
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