How embedded dental coverage shapes families' costs

By: Colin Reusch

A new study by the American Dental Association’s Health Policy Institute highlights the potential benefits of integrating children’s dental benefits into health plans, noting lower estimated out-of-pocket costs for most families compared to purchasing dental coverage separately.

The study, published by the Journal of Pediatrics, sheds new light on the potential financial impacts for families purchasing dental coverage on the state health insurance marketplaces under the Affordable Care Act (ACA).

By utilizing health and dental plan data on benefits and cost-sharing for dental services, the study’s authors created cost estimates for different patient profiles — ranging from young, healthy children in need of few dental services to adolescents needing more complex care. The study found that, on average, total out-of-pocket costs for children were likely to be lower in a health plan that embeds pediatric dental benefits than in a dental plan purchased separately. There were exceptions, namely older children who need more extensive dental work. As is expected, the estimated costs vary considerably across the individual marketplace plans included in the study (1,039 health plans and 538 stand-alone dental plans).

On average, total out-of-pocket costs for children were likely to be lower in a health plan that embeds pediatric dental benefits than in a dental plan purchased separately.

While many qualified health plans that include children’s dental benefits require families to meet a high medical deductible before accessing those dental benefits, the study found that in most cases families would still have lower out-of-pocket costs compared to a stand-alone dental plan.

These findings support the continued efforts to integrate dental coverage for children into private health plans on the marketplaces. To ensure that optimally affordable options are available, both the U.S. Department of Health and Human Services and states that manage their own should consider establishing standard health plan designs that incorporate pediatric dental benefits and protect children’s dental services from high medical deductibles.

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Did you know?

75% }
of American Indian/Alaskan Native children have experienced caries by age 5.
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